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Alameda County officials and health partners warn HR1 could push tens of thousands off Medi‑Cal and strain local safety‑net
Summary
County health officials, clinics and community groups told the Alameda County Together for All Ad Hoc Committee that proposed federal changes in HR1 and related policies could remove coverage for large numbers of Medi‑Cal enrollees, increase uncompensated care costs and require new county funding and coordination to preserve services.
Alameda County supervisors and health officials on Thursday heard stark warnings that proposed federal budget and policy changes captured in HR1 could cause large coverage losses and major budget shortfalls for the county's safety‑net.
Interim Alameda County Health Director Anika Choudhary told the Together for All Ad Hoc Committee that state estimates show about 3.4 million Californians could lose Medi‑Cal coverage under HR1 and that Alameda County could see more than 130,000 people bumped off Medi‑Cal over the next one to two years. "This is a phased but very significant coverage loss," Choudhary said, warning of increasing local costs and severe strain on hospitals and clinics.
Why it matters: Medi‑Cal is the core of the county’s health‑care safety net. County staff told supervisors that the HealthPAC indigent care budget (currently about $70 million) and partner providers such as Alameda Health System and federally qualified health centers (FQHCs) could face large funding gaps. Alameda Health System anticipates cuts of $5–15 million in 2026 rising to $70–120 million by 2028 if the federal and state financing changes occur as projected.
What county and partners are proposing: Health staff described contingency planning that includes coordinated Medi‑Cal outreach and enrollment campaigns to keep eligible residents enrolled, creation of shared data across agencies to measure enrollment and uncompensated care impacts, flexible use of the county HealthPAC program to maintain access, and regular briefings to the full Board. Choudhary recommended convening provider partners and community‑based organizations to align messaging and enrollment efforts.
Community partners stressed related impacts beyond insurance: Access to reproductive and gender‑affirming care, refugee resettlement services and food assistance will be affected if federal funding shrinks. Dr. George Ayala of the Public Health Department emphasized that food insecurity and housing instability would increase chronic disease burden and that cuts to programs such as SNAP‑Ed will remove vital prevention services.
What supervisors requested: Supervisors asked staff for a breakdown of how proposed federal changes translate to local fiscal impacts and requested regular (quarterly) updates to the full Board. They also urged immediate action on outreach and enrollment to reduce coverage loss and discussed prioritizing limited county dollars, including the recently allocated Measure W essential county services fund, to maximize impact.
Next steps: The committee directed staff to forward the presentations and recommendations to the full Board and requested a board letter focused on immigrant and refugee needs be prepared for an upcoming regular meeting. County staff said they will continue cross‑agency contingency planning and data alignment to better quantify impacts and options for mitigation.
Sources: Statements and data presented to the Alameda County Together for All Ad Hoc Committee by Interim Health Director Anika Choudhary, Alameda County Public Health Department, Alameda Alliance for Health estimates and partner organizations.
