\u201cWe\u2019re using these population figures as just an estimate,\u201d Prado said. \u201cIf more people fall into indigent care, these numbers just go up and up and up.\u201d<\/p>\n
Congress last summer approved the Trump Administration\u2019s H.R. 1<\/a>, known as \u201cThe One Big Beautiful Bill Act,\u201d which included cuts to the federal Medicaid program totaling nearly $1 trillion. Medicaid provides money for low income public health insurance programs in each state, including Medi-Cal in California.<\/p>\n About 520,000, or half, of Fresno County residents can access Medi-Cal, according to county staffers. Of those, about 153,000 have work requirements.<\/p>\n The federal bill requires a greater level of scrutiny than has been the policy of the past, including doubling the amount of audits for those who have work requirements. That would likely require more employees and staff time, staffers said.<\/p>\n The issues could be compounded by the state requirement for the county to provide care to those considered indigent, which city staffers said is more expensive than Medi-Cal. The county\u2019s average cost for Medi-Cal is about $4,000 per patient while the indigent care costs are about $8,000, staffers said.<\/p>\n \u201cIt\u2019s ironic that there\u2019s more scrutiny there, but yet we need more staff,\u201d Fresno County Chief Administrative Officer Paul Nerland said. \u201cIt\u2019s an advantage in Fresno County to keep more of our local population on Medi-Cal because it\u2019s less expensive through Medi-Cal than it would be to pay for it through our indigent care program.\u201d<\/p>\n Indigent care also is a large factor for those who need mental health care. Those with mild or moderate mental health care needs who can\u2019t qualify for Medi-Cal would likely fall into indigent care, according to Susan Holt, the director of Behavioral Health.<\/p>\n \u201cTheir impairment will escalate and they will hit our system completely unfunded,\u201d she said.<\/p>\n For residents who access Supplemental Nutrition Assistance Program (SNAP) benefits, what was once called food stamps, the county is held accountable for the \u201cerror rate.\u201d That includes those who have been awarded fraudulently and those awarded by mistake, city staffers said.<\/p>\n The county was penalized $2.9 million and $16.5 million in 2023 and 2024, respectively, for errors.<\/p>\n Staffers said the most recent year had an error rate of 4.25% but she said the rate could be much higher as HR 1 is implemented. She said a technical calculation at the state level determines the penalty amounts.<\/p>\n Supervisor Luis Chavez has expressed skepticism over the Trump Administration\u2019s efforts.<\/p>\n \u201cThe big ugly bill gets uglier as we discuss it more,\u201d he said.<\/p>\n Related Stories from Fresno Bee<\/p>\n