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Officials warn HR1 could strip health and food benefits and raise Alameda County costs
Summary
Legislative Analyst’s Office analysts and Alameda County staff told supervisors that federal HR1 will likely shrink Medi‑Cal and CalFresh rolls, increase county administrative costs and uncompensated care, and force the county to seek state support to avoid service gaps.
At a special budget work group meeting, Alameda County officials and analysts from the Legislative Analyst’s Office (LAO) outlined how the federal law HR1 and a tightening state budget could reduce Medi‑Cal and CalFresh enrollment and raise local costs.
The LAO analysts told the board that HR1 introduces new work and community‑engagement requirements, more frequent eligibility redeterminations and tightened rules for some legally present noncitizens that are likely to reduce caseloads. The analysts said projections of Medi‑Cal disenrollments vary widely and “we've put the disenrollment as much as 2,000,000 people,” but they emphasized the large uncertainty depending on implementation and state policy choices.
Why it matters: Medi‑Cal and CalFresh provide a major share of health and food assistance that counties depend on for program delivery and provider reimbursements. County staff said changes in federal participation, new state matches and higher administrative shares for CalFresh would increase county budgets and workload.
County staff laid out local exposure. Andrea Ford, Alameda County social services director, said the county currently serves roughly 400,000 medical enrollees and 170,000 CalFresh recipients and gave the county’s near‑term estimates: “about a 159,000 Alameda County residents may be subject to work requirements beginning in 2027. 14,600 are expected to lose coverage in 26‑27, rising to over 50,000 by 2030.” She urged state partnership and additional funding to avoid service disruptions.
LAO analysts also summarized statewide CalFresh projections, saying expanded work requirements could result in roughly 650,000 people statewide leaving CalFresh and that changes in how utility costs are counted will reduce monthly benefits for many recipients. They warned that federal reductions in administrative cost shares and the possibility of a state share tied to payment‑error rates could raise county administrative bills by millions.
County finance officials emphasized a double pressure of lower federal funding and higher local costs: fewer federal draws through provider taxes and tightened federal rules, along with potential federal penalties, could reduce the state funds that flow through to counties. The analysts and county staff recommended that the state consider targeted waivers, administrative funding, and automation tools to limit disenrollments caused by paperwork and implementation burdens.
Next steps: The county will continue to track the state May revision and federal rulemaking and pressed the LAO for follow‑up consultations. County leaders stressed that any significant local cost increases will need state assistance or alternate revenues to avoid cuts to services.
"We're committed to maintaining access to essential benefits and implementing new federal requirements responsibly," Ford said, while urging continued collaboration with the LAO and the state.
