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By Vanguard Staff<\/p>\n
SACRAMENTO, Calif. \u2014 California county leaders are urging the governor and Legislature to take immediate action to protect the state\u2019s safety net, warning that federal policy changes could shift billions in costs onto local governments and force deep cuts to essential services.<\/p>\n
According to county officials, H.R. 1 would shift billions in ongoing costs for health care, food assistance and other programs from the federal government to states and counties, with California estimating impacts of up to $9.5 billion annually.<\/p>\n
County leaders are proposing a multi-year state partnership that includes a $1.9 billion investment in the 2026\u201327 fiscal year and $4.5 billion the following year, describing it as the minimum needed to avoid widespread disruption to services.<\/p>\n
\u201cH.R. 1 fundamentally destabilizes California\u2019s safety net by shifting billions in new costs to counties that are already stretched thin, putting hundreds of thousands of residents at risk of losing care,\u201d said Santa Clara County Supervisor Susan Ellenberg, president of the California State Association of Counties. \u201cWithout immediate and sustained state partnership, the state\u2019s safety net will shatter and every service counties provide will be harmed.\u201d<\/p>\n
A detailed analysis of the legislation shows counties could face between $6 billion and $9.5 billion in annual health care costs alone as individuals lose Medi-Cal coverage and turn to county indigent care systems. Public hospital systems are projected to lose $3.4 billion annually due to changes in Medi-Cal financing, while workforce costs tied to eligibility requirements could add hundreds of millions more.<\/p>\n
County officials said the impacts extend beyond health care, warning that without state support, local governments may be forced to cut public safety, homelessness programs and election administration.<\/p>\n
\u201cCoverage losses under H.R. 1 will significantly increase pressure on county systems that are already stretched thin, particularly in rural areas where provider capacity and funding are more limited,\u201d said Mariposa County Supervisor Miles Menetrey, chair of the Rural County Representatives of California. \u201cAn immediate, coordinated partnership between the state and counties is essential to address these growing demands.\u201d<\/p>\n
Sacramento County Supervisor Rich Desmond, chair of the Urban Counties of California, said the measure represents a fundamental shift in how safety net services are funded.<\/p>\n
\u201cH.R. 1 represents a fundamental restructuring of the federal-state-county partnership for provision of safety-net services, with consequences that urban counties cannot absorb without significant policy and fiscal mitigation,\u201d Desmond said. \u201cWe urgently need the Governor and the Legislature to invest resources to shore up the foundation of safety net services to support low-income Californians.\u201d<\/p>\n
County leaders also warned that indigent care systems are not equipped to handle the surge in uninsured residents expected under the proposal.<\/p>\n
\u201cCounty indigent care programs are not equipped to absorb a surge of uninsured patients,\u201d said Michelle Gibbons, executive director of the County Health Executives Association of California. \u201cThese programs provide basic, subsistence-level services \u2013 not comprehensive care \u2013 and without a renewed state-local partnership, counties will struggle to meet even that core obligation.\u201d<\/p>\n
Officials said changes to eligibility requirements and funding structures would increase administrative burdens and lead to coverage losses, with millions of Californians at risk of losing Medi-Cal or facing barriers to accessing care.<\/p>\n
Michelle Cabrera, executive director of the County Behavioral Health Directors Association of California, said the policy changes could have cascading effects across multiple systems.<\/p>\n
\u201cAlthough most individuals with behavioral health needs will be exempt from work requirements, the confusion about eligibility and the significant administrative barriers contained in HR1 will have their intended effect, which is to force tens of thousands of existing clients off of Medi-Cal covered mental health and substance use disorder benefits,\u201d Cabrera said. \u201cWithout additional investment, those individuals and many more, will destabilize and wind up in an inhumane cycle of homelessness, substance use, and criminal justice involvement.\u201d<\/p>\n
Other leaders emphasized that the loss of coverage would ripple through local systems, increasing demand while reducing available resources.<\/p>\n
\u201cMany of the nearly 125,000 CMSP county residents that lose Medi-Cal due to H.R.1 will seek critical health care services from CMSP,\u201d said Kari Brownstein, executive director of the County Medical Services Program. \u201cWithout ongoing state financial support, CMSP will not be able to meet these essential needs.\u201d<\/p>\n
Carlos Marquez III, executive director of the County Welfare Directors Association of California, said the state still has time to act.<\/p>\n
\u201cCounties are deeply committed to keeping as many people as possible connected to CalFresh and Medi-Cal in the face of H.R. 1, and doing our part to reduce explosive future costs associated with hunger and uncompensated care,\u201d Marquez said. \u201cBut absent additional State investment, preventable losses in coverage and benefits will ensue for otherwise perfectly eligible low-income Californians.\u201d<\/p>\n
County leaders are calling on the state to include funding support in the governor\u2019s May budget revision, warning that failure to act could have long-term consequences for millions of residents who rely on safety net services.<\/p>\n
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