\u201cWe really are ground zero for the impact of this, just because of the number of people we have on public assistance in this county,\u201d Nerland told The Bee. \u201cWe\u2019re going to do everything we can to mitigate it. Is it still going to affect us in a big way? Absolutely.\u201d<\/p>\n
The bill also called H.R.1 approved last summer by Congress included about $1 trillion in cuts to the federal Medicaid program, which provides money for low-income public health insurance programs in each state, including Medi-Cal in California.<\/p>\n
About half, or 520,000, of Fresno County<\/a> residents are enrolled in Medi-Cal, according to county staffers. Of those, about 153,000 have work requirements.<\/p>\n Medi-Cal has subsidized the premiums for those folks, but the H.R.1 cuts mean fewer dollars for that subsidy. So the unfunded mandate falls onto the counties, Nerland noted.<\/p>\n \u201cThere\u2019s no coverage for that,\u201d he said. \u201cSo we have to find other places to cut to pay for those unfunded mandates.\u201d<\/p>\n When adopting the budget June 30<\/a>, the state included another $20 million for Fresno County. That money can be used to pay for the increased workforce the county will need to check eligibility for residents looking for public assistance, which are new more restrictive requirements under H.R.1.<\/p>\n The county will begin to have its clearest picture of what the H.R.1 cuts mean midway through the fiscal year, around late January.<\/p>\n Staffers estimate between 11,000 and 30,000 people in Fresno County will fall off of the Medi-Cal subsidy because they no longer fit the new requirements under the Big Beautiful Bill.<\/p>\n Paying for their health care would fall on the county.<\/p>\n Fresno County has a discretionary fund of about $400 million in its $5.3 billion pocketbook. But realistically, according to Nerland, if next year\u2019s budget picture does not improve, the county will see cuts to public safety.<\/p>\n Until then, the county has put a 5% cut mandate across most departments, he said. The Board of Supervisors has also placed a 12% transient-occupancy tax on the November ballot<\/a> that, if approved, is estimated to add $4.55 million to the county\u2019s challenged coffers.<\/p>\n \u201cYou\u2019re going to see a lot more positions vacant while we try to maintain savings to go forward. But after this, we\u2019ll have pulled most of those levers, and we\u2019re going to be to the point where we\u2019re going to have to cut services,\u201d Nerland said. \u201cThat\u2019s the only next step we have.\u201d<\/p>\n This story was originally published July 9, 2026 at 7:13 AM.<\/p>\n Related Stories from Fresno Bee<\/p>\n Paul Nerland became Fresno County\u2019s chief administrative officer in December 2021, ascending to the county\u2019s top bureaucrat position from operating officer. Courtesy of Fresno County FRESNO COUNTY <\/p>\n