Contra Costa preparing for Medi-Cal coverage loss, funding reductions
By Contra Costa Health
Contra Costa County must prepare for significant reductions in Medi-Cal coverage and hundreds of millions of dollars in long-term funding loss as a result of recent federal and state policy changes, county officials said Tuesday.
New federal requirements under H.R. 1, the “One Big Beautiful Bill Act,” combined with state Medi-Cal eligibility and reimbursement changes, will make it harder for many residents to enroll in or keep healthcare coverage. While final details are still emerging, county estimates indicate that as many as 93,000 Contra Costa residents could be affected by 2029.
At the same time, Contra Costa Health (CCH) projects more than $300 million in cumulative state and federal funding reductions through 2029, driven by Medi-Cal disenrollment and cuts to supplemental funding that public hospitals rely upon. These impacts are expected to grow year over year and reflect a broader trend affecting counties and public health systems across California.
“These changes mean fewer people covered and fewer dollars coming into the system at the same time,” said Candace Andersen, Chair of the Contra Costa County Board of Supervisors. “Our responsibility is to face that reality head-on, plan carefully, and ensure the county continues to provide essential care for residents who have nowhere else to turn.”
During a presentation to the Board on Tuesday, leaders of CCH and the county’s Employment & Human Services Department (EHSD) emphasized that the projected impacts are a result of external policy decisions, not local performance, and that significant uncertainty remains around timelines, enforcement and the response from California.
Federal guidance on several provisions of H.R. 1 has not yet been issued, and California’s approach to mitigating coverage losses is still evolving.
The presentation outlined how specific provisions of H.R. 1 and recent state Medi-Cal policy changes are expected to reduce enrollment, increase administrative barriers to coverage, and lower reimbursement to safety-net providers. It also reviewed projected enrollment losses, funding impacts to CCH and Contra Costa Health Plan, and the anticipated timing of changes, along with areas of ongoing uncertainty.
The Board directed CCH to return in early 2026 with a proposal to update and strengthen the county’s existing supports for people who are not eligible for Medi-Cal and have no other healthcare options.
Contra Costa County will share additional updates as federal and state guidance becomes available and planning continues.
the attachments to this post:
CCHealth logo 2023 & Medi-Cal logo wide
