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County officials warn federal reconciliation and state May revise could sharply cut Medi‑Cal and SNAP support
Summary
Angie Melton, a consultant with the Margolin Group, told the committee the House reconciliation bill and recent manager's amendments would accelerate Medicaid eligibility checks, cap supplemental payments and could reduce federal support for state‑only programs, creating large potential enrollment and revenue losses for Santa Clara County.
Angie Melton, a consultant with the Margolin Group, told the Santa Clara County Health and Hospital Committee that the House of Representatives passed a budget reconciliation bill that, as drafted, would substantially change Medicaid and nutrition assistance rules and could produce large coverage losses for California.
Melton said the House bill, which passed narrowly, would cap future state‑directed payments at a percentage of Medicare, prohibit new or increased provider taxes, accelerate eligibility redeterminations to every six months, and extend cost sharing for some Medicaid expansion enrollees. "The manager's amendment ... moved that timeline ... until the end of 2026," Melton said, adding that the Congressional Budget Office's earlier score showed coverage losses and that the changes will likely increase those losses.
County leaders told the committee they expect both administrative burden and revenue losses. A county official speaking during the meeting said the proposal to reduce the federal match for populations covered through state‑only programs (including undocumented residents) would be “a loss of money that's being paid by the federal government” and cited a Kaiser Family Foundation estimate of roughly $30 billion in reduced federal support for California over ten years.
James (county executive) outlined local operational consequences: twice‑annual eligibility checks and work‑rule validations could knock thousands of people off Medi‑Cal even if they meet the requirements, he said, adding that counties would face heavy administrative workloads, revenue shortfalls and more uncompensated care as residents lose coverage.
Paul Lorenz, speaking for the county health system, urged coordination with state legislators and described outreach the county has undertaken in Sacramento to explain risks to public hospitals. "If the legislature doesn't pay special attention to the public hospital systems like us ... they're jeopardizing really critical infrastructure," he said, noting public hospitals' outsized role in trauma, burn and specialist care.
County officials urged the state legislature to defer any state‑level Medi‑Cal cuts until the federal process plays out so policymakers can avoid compounding enrollment losses.
Committee members moved to receive the report; the motion passed with the vice chair and chair voting aye.
