Mono County officials warned HR 1 changes could push thousands back onto county health program

Carrie Brownstein, executive director of the County Medical Services Program, told the Mono County Board of Supervisors on Feb. 17 that federal and state policy changes packaged in what county staff described as “HR 1” could return substantial numbers of people to CMSP and increase county financial exposure.

“The big thing that’s going to affect CMSP is the work requirements,” Brownstein said, explaining that staff estimates range from about 43,000 to more than 131,000 people statewide who could be affected. She said that, depending on exemptions and rollout timing, CMSP’s medical cost exposure could be hundreds of millions annually if the state and federal rules are implemented without new funding.

Kathy Petersen, Mono County health and human services director, said Mono’s local estimates are smaller but consequential: “We estimate 1,000 to 1,500 Mono individuals will be subject to the new rule,” she said, adding that exemptions (for people 65 and older, pregnant people, parents of young children, people with disabilities and others) will reduce the number who ultimately lose coverage. Petersen emphasized the administrative burden: enrollment redeterminations will move to six‑month cycles for the ACA expansion population starting Jan. 1, 2027, and staff will need to verify exemptions and process increased churn.

County staff described multiple program changes that will affect local providers and budgets: reinstated asset limits and enrollment freezes for some immigration statuses; loss of some full‑scope dental benefits; shorter retroactive coverage windows; potential small monthly premiums and co‑payments for certain services; and new CalFresh work requirements and reduced federal administrative match beginning October 2026. Petersen told supervisors the county estimates an annual CalFresh administrative cost increase of roughly $135,000.

Supervisor questions focused on operational readiness. Francie Evita and Yvonne Freeman, Mono County eligibility staff, described the likely “churn” of people losing coverage, reapplying, and being evaluated for CMSP or other programs — work that requires staff time and more frequent, direct outreach. “We anticipate about 100 additional Medi‑Cal renewals per month related to the six‑month redeterminations,” Petersen said, noting an estimated 1.2 staff hours per renewal and recommending additional eligibility staff and training.

Brownstein said CMSP’s governing board is weighing reinstating county participation fees and other eligibility changes to fit the program’s budget; Mono’s current CMSP participation fee was listed as $25,469 per year. She cautioned that without new resources the CMSP board could invoke a risk allocation that would ask counties for additional contributions.

Board members urged continued advocacy through CSAC and other associations and asked staff to coordinate outreach with local providers, the hospital and managed‑care plans to reduce coverage gaps. Several supervisors also recommended expanding public information about renewals, exemptions and enrollment options.

The presentation concluded with staff pledging to return with more local numbers, outreach plans and any needed budget proposals as federal and state details are finalized.