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CSAC CEO warns HR1 could squeeze county budgets, outlines $1.9 billion funding request
Summary
Graham Knott, CEO of the California State Association of Counties, told the Tulare County Board that federal and state changes under HR1 could lead to coverage losses and increased county costs; CSAC is asking for roughly $1.9 billion in the next budget year to help counties meet new mandates and staffing needs.
Graham Knott, chief executive officer of the California State Association of Counties, told the Tulare County Board of Supervisors on March 24 that recent federal and state policy changes grouped under “HR1” would impose new administrative burdens on counties and could cause “close to a million and a half” people to lose health coverage unless the state funds mandated responsibilities.
Knott said counties must receive both clarity and funding from higher levels of government to implement new eligibility and work-reporting requirements for Medi‑Cal and CalFresh recipients. “Counties can’t do what the state doesn’t fund,” he said, urging a coordinated push in Sacramento and Washington, D.C., to secure resources for local implementation.
Why it matters: Knott framed the issue as an affordability and operations problem for counties. He said additional verification and eligibility workload could require residents who are hourly-paid to take unpaid time off to prove they meet new rules, creating barriers to continued benefit receipt and placing added strain on county eligibility staff.
Knott outlined a phased CSAC budget request to the legislature that he said is “just shy of $2 billion” for the upcoming budget year and would rise to about $4.5 billion under fuller implementation in 2027–28. He broke the current-year request into several line items: roughly $761 million for indigent care infrastructure, $500 million for public hospitals, $373 million to bolster eligibility staffing for Medi‑Cal and CalFresh, and $224 million for behavioral‑health services to cover people who might lose Medi‑Cal. Knott said separate advocacy is under way for rural hospitals that face closures.
Board members pressed for details. A supervisor asked whether the $500 million for public hospitals includes rural hospitals; Knott said rural hospital support is being pursued separately but remains a high priority. The board also discussed local implementation of Proposition 36 and state smart‑water planning (SB72), both on CSAC’s legislative agenda.
CSAC also previewed education materials and said the organization will post its analysis and proposal at csac.counties.org for county officials. Paul Dancheck, chief operating officer of the CSAC foundation, separately recognized local employees who completed the CSAC Institute credential program.
What happens next: Knott urged supervisors to press the county’s legislative delegation and to participate in CSAC’s legislative conference in May, when county leaders plan to press for funding in the final stages of the state budget process.
