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SACRAMENTO, Calif. \u2014 California county leaders are warning that a proposed federal policy could shift billions in safety net costs onto local governments, threatening health care access, behavioral health systems and other essential services while increasing the risk of homelessness and cuts to local programs, according to a statement released by the California State Association of Counties.<\/p>\n
According to the CSAC statement, H.R. 1 would transfer \u201cbillions in ongoing costs for health care, food assistance, and other safety net programs\u201d from the federal government to states and counties, resulting in an estimated $9.5 billion annual burden for California.<\/p>\n
The CSAC statement explains that counties have proposed a multi-year solution, including a $1.9 billion investment in fiscal year 2026-27 and $4.5 billion the following year, describing it as the \u201cminimum needed to prevent widespread disruption to essential services.\u201d<\/p>\n
According to the CSAC statement, without state action, the legislation\u2019s cuts will \u201cdemolish California\u2019s safety net and force cuts to critical local services.\u201d<\/p>\n
\u201cCalifornians who turn to counties after losing their health coverage will not get the care they need,\u201d the CSAC statement asserts, adding that \u201cevery public hospital system patient will feel the pain.\u201d<\/p>\n
The CSAC statement notes that counties will face \u201cmajor new costs\u201d to verify eligibility for Medi-Cal and CalFresh, while behavioral health systems will experience increased demand as more individuals lose coverage.<\/p>\n
According to the CSAC statement, the impacts will extend beyond health care, warning that counties may be forced to cut \u201cpublic safety, homelessness programs, election administration and more.\u201d<\/p>\n
Santa Clara County Supervisor Susan Ellenberg, CSAC president, said H.R. 1 \u201cfundamentally destabilizes California\u2019s safety net,\u201d according to the CSAC statement.<\/p>\n
\u201cWithout immediate and sustained state partnership, the state\u2019s safety net will shatter and every service counties provide will be harmed,\u201d Ellenberg said.<\/p>\n
Mariposa County Supervisor Miles Menetrey said \u201ccoverage losses under H.R. 1 will significantly increase pressure on county systems that are already stretched thin,\u201d particularly in rural areas with limited resources, according to the CSAC statement.<\/p>\n
Sacramento County Supervisor Rich Desmond described the legislation as a \u201cfundamental restructuring of the federal-state-county partnership,\u201d stating that counties \u201ccannot absorb\u201d the changes without \u201csignificant policy and fiscal mitigation,\u201d according to the CSAC statement.<\/p>\n
\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 Desmond said.<\/p>\n
According to the CSAC statement, county leaders warn that reduced coverage will increase reliance on indigent care systems that are already limited.<\/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.<\/p>\n
\u201cThese programs provide basic, subsistence-level services \u2014 not comprehensive care,\u201d Gibbons added.<\/p>\n
The CSAC statement further highlights concerns that administrative barriers will cause individuals to lose coverage even when they remain eligible.<\/p>\n
\u201cPreventable losses in coverage and benefits will ensue for otherwise perfectly eligible low-income Californians,\u201d said Carlos Marquez III of the County Welfare Directors Association of California.<\/p>\n
According to the CSAC statement, behavioral health leaders also warned of broader consequences tied to reduced access to care.<\/p>\n
\u201cWithout additional investment \u2026 individuals will destabilize and wind up in an inhumane cycle of homelessness, substance use, and criminal justice involvement,\u201d said Michelle Cabrera of the County Behavioral Health Directors Association of California.<\/p>\n
According to the CSAC statement, county leaders are urging the governor to address the issue in the upcoming May budget revision.<\/p>\n
\u201cThere\u2019s still time to keep people connected to our safety net,\u201d Marquez said. \u201cLet\u2019s not let this opportunity pass us by.\u201d<\/p>\n
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