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Legislators Press for County‑by‑County Baseline as HR1‑driven Coverage Losses Loom
Summary
Lawmakers and state analysts told a Budget Subcommittee that reliable, comparable county data on indigent care does not exist and that building a statewide, timely baseline likely will take years; officials urged interim reporting and coordination while counties prepare for immediate demand.
Chair Greg Hart opened the Assembly Budget Subcommittee No. 7 hearing by framing the issue: rising numbers of Californians may lose Medi‑Cal and Covered California coverage under federal HR1 and the state needs better data to plan a response.
Will Owens of the Legislative Analyst’s Office told members counties have wide discretion under Welfare and Institutions Code §17000 and that data on caseloads, benefits and eligibility is dispersed. "Much of this data is, at the county level, dispersed," Owens said, urging a county‑by‑county baseline that would let the Legislature assess fiscal implications and program capacity.
Members repeatedly asked how quickly such a system could be assembled. Tyler Sadwith, the Medicaid director at the Department of Health Care Services, said a comprehensive, comparable statewide data platform would "take years" to stand up because counties collect indigent‑care information in many different ways and HCAI hospital/clinic data lags years. "We're talking, to the point of, being able to receive and digest useful... apples‑to‑apples equivalent information. I would say, years," Sadwith said.
Officials identified intermediate steps: use existing HCAI encounter data where possible, direct a lead state agency (DHCS or HCAI) to coordinate reporting, or adopt limited statutory reporting requirements to collect a minimal baseline for near‑term budgeting. The panel cautioned that even available hospital utilization data does not capture where disenrolled Medi‑Cal members go after losing coverage and that matching Medicaid disenrollments to subsequent employer coverage or Covered California enrollment requires cross‑system data sharing and time.
Why it matters: without a timely baseline, legislators said they risk allocating scarce state resources inefficiently in the next budget cycle. Multiple members urged short‑term measures for January while the state and counties work toward a more standardized reporting system.
