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County health officials warn HR1 and federal shutdown risks could raise uninsured rates, cut grants and strain behavioral health
Summary
County health leadership told the Healthcare Services Review Committee that the federal government shutdown and proposed HR1 changes could reduce federal grant draws, cut housing and sober‑living supports, and raise the county’s uninsured population — increasing demand for crisis and emergency services.
Brandy Hopkins, a county official who opened the federal and state impacts briefing on Oct. 15, told the committee the immediate effect of a federal shutdown would be delays in grant payments that primarily affect behavioral health and public health. “The biggest impact of government shutdown will actually hit behavioral health and public health who both receive federal grant dollars,” Hopkins said.
Hopkins and other department leaders described three interlocking concerns: a federal shutdown that pauses appropriations and delays grant draws, HR1 policy proposals that would change eligibility for programs (including SNAP and some supplemental housing supports), and changes in Medi‑Cal enrollment patterns that already have reduced managed Medi‑Cal assignments for some clinics.
Matt Garver (presenter for clinics) said regular clinic operations have low immediate payment risk but that congressional‑directed spending pauses could delay specific expansion projects such as the Lodi expansion clinic lease and drawdowns. Hopkins said public health and emergency response grants used for preparedness and other mandates could be eliminated under HR1 over the next two fiscal years, and behavioral health staff estimated potential loss of positions and services: about 7.5 FTEs tied to programs at risk and roughly $5 million of housing‑related payments subject to change.
Behavioral health leaders told the committee they expect up to 90 clients (people referenced as undocumented or without “good citizenship” status in the presentation) to lose eligibility for certain transitional housing supports, which could raise shelter demand and emergency services utilization. Presenters said the county is planning mitigation steps — for example, building voluntary employment and transitional opportunities at the Be Well campus to reduce future crisis demand — but noted that state responses to federal changes are unknown and will influence local impacts.
Committee members asked that hospital and clinic leaders prepare examples and data for upcoming legislative advocacy meetings. Hopkins and healthcare services staff said they will return with more detailed impact analyses next quarter and will track grant timing, benefit eligibility changes and potential staffing effects.
