Monterey County officials warn HR1 changes could sharply cut Medi‑Cal, CalFresh support and strain Natividad

Monterey County health officials and the CEO of Natividad hospital told the Board of Supervisors on Sept. 30 that federal and state changes tied to HR1 (the federal reconciliation bill) will shrink enrollment, increase administrative work and risk substantial funding losses for local safety‑net providers.

The warning came during a staff briefing on the timeline and local effects of HR1 and the 2025–26 California budget. Roderick Franks, director of Social Services, said the situation is "still an evolving environment" and that available guidance could change federal and state implementation details.

County officials said effects begin as early as Jan. 1, 2026, when an asset test for some Medi‑Cal enrollees will be reinstated and when adults in some immigration status categories will no longer be eligible for new full‑scope Medi‑Cal enrollments. The county’s summary showed several points of concern: frequent redeterminations (every six months for some groups), reinstated asset limits, new copay or premium provisions for some enrollees and a possible cost shift in CalFresh administrative funding.

Why it matters: Monterey County has a higher share of residents who rely on Medi‑Cal and related programs than many California counties. Dr. Chad Harris, CEO of Natividad, said loss of federal support for supplemental payments and disproportionate share hospital (DSH) funding could be large. "If those funds were not extended, [the DSH] impact…would be approximately $14,000,000 per year to Natividad," Harris said. County staff said a shift in CalFresh administrative cost share could add roughly $2,000,000 in county costs if shared proportionally.

What officials said: Roderick Franks emphasized the administrative and client‑service implications: more frequent redeterminations mean more outreach and document collection for roughly 61,000 enrollees in Monterey County who would face 6‑month reviews. He added that roughly 13,000 people could be affected by an asset test and that about 39,000 currently enrolled residents have the immigration status identified in the state changes.

Elsa Jimenez, director of Public Health, described clinic impacts: the county’s federally qualified health centers would see lower Medi‑Cal reimbursement for a subset of patients and lost program grants. "About 23% of our patients assigned to our federally qualified health centers have a [unsatisfactory immigration] status," Jimenez said, adding that fee‑for‑service reimbursements would be far lower than the county’s current prospective payment rates.

Local planning and action: Supervisors pressed staff for immediate outreach. The board authorized a $250,000 county allocation to support community outreach and education — a program staff said would be run with community‑based organizations, radio/TV and social media messaging and on‑site enrollment assistance to reach people before Jan. 1, 2026. The board asked staff to return Oct. 14 with a detailed plan.

Public and board reaction: Public commenters called the legislation "cruel" and warned of broader community impacts. Supervisors stressed urgency: "If there ever was a time when we needed funds available to invest in a program that bolstered...community outreach workers, it would be now," Supervisor Lopez said.

What’s next: County staff will coordinate county clinics, Natividad and community partners to run a rapid outreach campaign over the fall and incorporate the county’s plan into the Oct. 14 board agenda. Staff also committed to return with more detailed financial estimates as federal and state guidance arrives.

Ending: County officials said they will continue tracking federal rollouts and state guidance; the board directed staff to prioritize outreach and return with a plan and budget to mitigate enrollment loss and protect local safety‑net access.