SACRAMENTO, Calif. — 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.
According to the CSAC statement, H.R. 1 would transfer “billions in ongoing costs for health care, food assistance, and other safety net programs” from the federal government to states and counties, resulting in an estimated $9.5 billion annual burden for California.
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 “minimum needed to prevent widespread disruption to essential services.”
According to the CSAC statement, without state action, the legislation’s cuts will “demolish California’s safety net and force cuts to critical local services.”
“Californians who turn to counties after losing their health coverage will not get the care they need,” the CSAC statement asserts, adding that “every public hospital system patient will feel the pain.”
The CSAC statement notes that counties will face “major new costs” to verify eligibility for Medi-Cal and CalFresh, while behavioral health systems will experience increased demand as more individuals lose coverage.
According to the CSAC statement, the impacts will extend beyond health care, warning that counties may be forced to cut “public safety, homelessness programs, election administration and more.”
Santa Clara County Supervisor Susan Ellenberg, CSAC president, said H.R. 1 “fundamentally destabilizes California’s safety net,” according to the CSAC statement.
“Without immediate and sustained state partnership, the state’s safety net will shatter and every service counties provide will be harmed,” Ellenberg said.
Mariposa County Supervisor Miles Menetrey said “coverage losses under H.R. 1 will significantly increase pressure on county systems that are already stretched thin,” particularly in rural areas with limited resources, according to the CSAC statement.
Sacramento County Supervisor Rich Desmond described the legislation as a “fundamental restructuring of the federal-state-county partnership,” stating that counties “cannot absorb” the changes without “significant policy and fiscal mitigation,” according to the CSAC statement.
“We urgently need the Governor and the Legislature to invest resources to shore up the foundation of safety net services to support low-income Californians,” Desmond said.
According to the CSAC statement, county leaders warn that reduced coverage will increase reliance on indigent care systems that are already limited.
“County indigent care programs are not equipped to absorb a surge of uninsured patients,” said Michelle Gibbons, executive director of the County Health Executives Association of California.
“These programs provide basic, subsistence-level services — not comprehensive care,” Gibbons added.
The CSAC statement further highlights concerns that administrative barriers will cause individuals to lose coverage even when they remain eligible.
“Preventable losses in coverage and benefits will ensue for otherwise perfectly eligible low-income Californians,” said Carlos Marquez III of the County Welfare Directors Association of California.
According to the CSAC statement, behavioral health leaders also warned of broader consequences tied to reduced access to care.
“Without additional investment … individuals will destabilize and wind up in an inhumane cycle of homelessness, substance use, and criminal justice involvement,” said Michelle Cabrera of the County Behavioral Health Directors Association of California.
According to the CSAC statement, county leaders are urging the governor to address the issue in the upcoming May budget revision.
“There’s still time to keep people connected to our safety net,” Marquez said. “Let’s not let this opportunity pass us by.”
Follow the Vanguard on Social Media – X, Instagram and Facebook. Subscribe the Vanguard News letters. To make a tax-deductible donation, please visit davisvanguard.org/donate or give directly through ActBlue. Your support will ensure that the vital work of the Vanguard continues.
Categories: Breaking News Health Issues Homeless State of California Tags: Behavioral Health California counties CSAC Homelessness Medi-Cal safety net cuts