Contra Costa County officials are monitoring the effects of recent federal and state policy changes, including the passage of the federal reconciliation bill (H.R. 1). The new legislation brings significant cuts to Medicaid (Medi-Cal) and SNAP (CalFresh), along with stricter eligibility requirements for both programs.
According to county officials, these policy changes shift unfunded costs to Contra Costa County, increase administrative burdens, and will limit access to healthcare and food assistance for thousands of local residents. The county currently manages the Contra Costa Health Plan (CCHP), which serves about 270,000 people through its public hospital and nine community clinics.
The updated eligibility rules could impact nearly half of all Medi-Cal enrollees in Contra Costa County. Projections indicate that up to 93,000 residents may lose coverage by 2029 as a result of these changes.
Specific alterations to Medi-Cal eligibility are scheduled over the next year. Beginning January 1, 2026, adults aged 19 and older classified as having “Unsatisfactory Immigration Status” (UIS)—including undocumented residents and others who do not meet federal criteria—will be barred from enrolling in full-scope Medi-Cal. This restriction also applies to seniors. The county is encouraging undocumented adults who are currently eligible for Medi-Cal to enroll before the end of this year while they still qualify. More information can be found on the county’s website: https://www.cchealth.org/Home/Components/News/News/977/414
Additional changes take effect later in 2026. On July 1, adults with UIS will lose access to state dental services. By October 1, the definition of UIS will expand to include groups such as refugees, asylees, and other non-citizens who were previously exempted; these populations will also face loss of coverage.
Financially, Contra Costa County has already experienced a $24 million reduction this year due to funding cuts and new unfunded mandates associated with these policy shifts. Looking ahead, annual losses tied to future Medi-Cal changes are projected at approximately $307 million by fiscal year 2028-29. This comes at a time when public hospitals, clinics, and health plans across California face increased demand despite fewer resources.
Key factors driving these projected losses include $159 million due to disenrollment stemming from revised eligibility rules and $148 million related to reductions in supplemental state and federal healthcare funding for current Medi-Cal recipients.
County leaders state: “Contra Costa County remains committed to protecting core services, monitoring the impacts of H.R. 1, and keeping the community informed.”
Important upcoming dates include a Health Services Department presentation on December 16 regarding H.R. 1 and state healthcare policy changes; an annual Board Retreat on February 3; and budget hearings scheduled for April 27–28.