CSAC warns Inyo County HR 1 will shift safety‑net costs to counties; local officials asked to lobby for state aid

CSAC senior advocates on April 28 told the Inyo County Board of Supervisors that HR 1 — the federal law that retools Medi‑Cal and CalFresh eligibility and financing — will shift substantial costs from federal to state and county budgets and warned that Inyo County could face meaningful new demands on its general fund if the state does not provide relief.

Dustin Garrett of the California State Association of Counties (CSAC) said HR 1 institutes work or community engagement requirements, increases the frequency of eligibility redeterminations and changes Medicaid financing that underpin public hospitals. He told the board CSAC has calculated a multi‑billion‑dollar exposure statewide and has submitted a multiyear budget request to the state to help counties implement the law.

"HR 1 fundamentally shifts fiscal responsibility for safety‑net programs from the federal government to states and counties," Garrett said. He outlined CSAC’s advocacy ask for the May and June budget processes and asked Inyo County to send a support letter backing the statewide request.

Danielle Bridal, CSAC’s health‑policy presenter, described four areas driving the demand on counties: indigent care programs (County Medical Services Program), public hospitals and health systems, county eligibility workforce needs, and county behavioral health services. Bridal said CSAC’s short‑term statewide budget request to the governor and legislature includes funding for start‑up infrastructure, eligibility staff and public‑hospital stabilization.

At the local level, Health and Human Services Director Scott told the board the county has run calculations to estimate Inyo’s exposure. He said Inyo’s preliminary local estimates include about $130,000 per year in increased CalFresh‑administration costs at current enrollment levels and, under a working assumption that one‑third of people losing Medi‑Cal would seek indigent county care, roughly $1.5 million per year in indigent care costs — a sum that would overwhelm Inyo’s remaining public‑health realignment funds and force difficult general‑fund tradeoffs.

"Indigent care is our biggest risk at the local level to county general fund," Scott said, urging county leaders to support CSAC’s state budget asks and to press the May revise and June budget negotiations for county resources.

Supervisors asked how state funding would be distributed and what would happen if the state does not cover the new costs. CSAC said some allocations would flow through existing channels (departmental allocations for eligibility work through state social services or DHCS processes), but indemnifying counties for indigent care will require additional policy decisions and potentially new distribution formulas.

Next steps: CSAC recommended counties send support letters, engage delegations in the May‑June budget window and track the governor’s May revise. Board members expressed general support for the CSAC advocacy plan and for Inyo staff to return with any local requests required to support implementation.

Why it matters: The changes to eligibility and redeterminations under HR 1 begin in the coming months; the board was told the May revise (May 14) and the legislature’s June budget deadline are critical milestones for securing state funding to avoid cuts to other county services.