County staff briefed the board on federal HR 1 and a state bill affecting emergency flows, summarizing the policy changes and potential local impacts on public assistance programs and rural health providers.

Joanne Johnson, project coordinator for the county administration office, told supervisors that HR 1 will change how CalFresh (California's name for SNAP) and Medi-Cal (California's Medicaid program) are administered beginning in 2027. Johnson said the state's share of CalFresh administrative costs would increase to 75% from the current 50% split and that California may become responsible for a portion of CalFresh benefit payments depending on the program's payment-error rate. Johnson said work requirements for CalFresh would expand to adults up to age 64.

On Medi-Cal, Johnson said changes include a new work requirement beginning in 2027, income verification every six months, the end of automatic reenrollment and the expiration of enhanced premium tax credits for Covered California plans. Citing the California Health and Human Services Agency, Johnson said these changes could cause as many as 3.4 million Californians to lose health coverage, double workload for eligibility staff and raise premiums by an estimated 66% for subsidized enrollees.

Johnson said in Siskiyou County more than 40% of residents are enrolled in Medi-Cal and that reductions in coverage would reduce reimbursement to local providers, including Siskiyou County Behavioral Health and local hospitals. She noted a federal rural health transformation fund is available but currently limited in duration and that funding allocation details depend on state application and federal rules.

Fairchild Medical Center told staff it anticipates significant cuts because Medicare and Medicaid reimbursement comprise roughly 75% of its business; Mercy Medical Center in Mount Shasta said it was evaluating potential impacts and whether a rural support fund would offset expected losses. Both hospitals told staff the full financial effect is uncertain and likely will require 12 to 18 months to assess, Johnson said.

Staff said the state is awaiting federal implementation guidance; once that arrives, county and state agencies will develop mitigation strategies and instructions for local administration.