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Contra Costa health officials warn HR1 and state changes could strip coverage from tens of thousands
Summary
County health and human services officials told the Board of Supervisors that federal HR 1 and state Medi‑Cal changes could put roughly 93,000 county residents at risk of reduced coverage and strip up to $307 million from the local health system through 2029; staff recommended expanding navigators, enrollment help, and reviewing the county basic health care program.
Contra Costa Health and the county Employment & Human Services Department told the Board of Supervisors that proposed federal and state policy changes — including HR 1 — would sharply reduce eligibility and funding for Medi‑Cal and related supplemental payments, putting hundreds of millions of dollars at risk and threatening coverage for a substantial number of county residents.
Dr. Grant Colfax, Contra Costa Health director, said the county estimates as many as 93,000 people could be affected by a combination of federal HR 1 provisions and state Medi‑Cal policy changes. “These changes will affect individuals and families, including the most vulnerable in our community,” he said, noting potential ripple effects for hospitals, clinics and county public health services.
Marla Stewart, Director of Employment & Human Services, walked the board through a phased timeline of policy changes that begin in 2026 and extend through 2028: reinstated asset tests, a freeze on full‑scope enrollment for undocumented adults after Jan. 1, 2026, dental and benefit reductions, ACA‑expansion work/community engagement requirements beginning Jan. 1, 2027, and new premiums and copay possibilities. Stewart said the county projects federal, state and local funding reductions of roughly $307 million through 2029 under a mid‑range scenario.
Staff emphasized uncertainty — regulations and implementation details remain incomplete — but urged early investments in keeping people enrolled to avoid greater downstream costs. Stewart detailed two near‑term mitigation options: (1) a Measure X‑funded “Empowering Enrollment” contract that pays community‑based organizations $110 per approved renewal (targeting roughly 17,000 renewals for ~$1.9M), and (2) navigator expansion (estimated ~$2.3M for additional staff) to reduce procedural churn that causes eligible people to fall off coverage.
Supervisors stressed prevention as a cost‑effective approach. One board member framed the choice as paying modestly now to preserve enrollment (and avoid higher future costs) versus paying significantly more later to cover uninsured residents in a county‑run basic health program. The board directed health staff to return in early 2026 with options for amendments to the county basic health care program, and to continue coordination with community clinics and partners on enrollment work.
Staff also flagged that local hospitals and clinics and community partners should be engaged early, and that any decisions about changes to eligibility or benefits will be brought back to the board for explicit direction.
