Supervisors resurrect Esperanza pilot to bring health care to some residents losing Medi-Cal.

Esperanza Care, a former program that brought health care to more than 6,500 uninsured Monterey County residents between 2015 and 2023, is being resurrected after a 5-0 vote of the Board of Supervisors on Tuesday, Jan 27.

Supervisors made the unanimous decision in the face of an estimated 27 percent of residents on Medi-Cal expected to lose coverage over the next two years due to new federal requirements and restrictions on eligibility due to immigration status.

The vote means the county will move forward on creating a new Esperanza pilot to cover 500 adults with an income at 100 percent of the federal poverty level, with plans to expand as funds become available. (Current poverty level in Monterey County is $15,650 for an individual and $32,150 for a family of four.)

It’s set to begin July 1, 2026 and could cost between $500,000 to $1 million over a 12-month period, according to Dr. Chad Harris, CEO of Natividad Medical Center, and Elsa Jimenez, director of the Monterey County Health Department.

“This is a tool to get us through a gap, as it was before,” said Supervisor Chris Lopez, referencing the original program, which ended in 2023 after Medi-Cal, California’s version of federal Medicaid, was expanded to include more people previously excluded due to their immigration status. Under President Donald Trump’s so-called One Big Beautiful Bill, House Resolution 1, Medi-Cal expansion is now frozen, leaving ineligible adults with only Medi-Cal emergency care and pregnancy care.

“We solved the bigger problem, unfortunately a lot of folks didn’t agree with us at the federal level and put us in a position where we have to bring this program back,” Lopez said, adding that providing less costly preventative care was good for people and their families but also makes good financial sense by preventing expensive interventions down the line.

“That bill will still fall on one place, this county,” he said. “That is the risk we’re trying to avert, by doing the right thing to keep our community healthy. It’s a smart fiscal choice.” He also called it “good policy, putting human beings first.”

The original pilot and subsequent program cost the county around $12 million between 2012 and 2023, Harris reported. The breakdown included: primary care delivered through Health Department clinics at a cost of approximately $7.6 million; pharmacy services through Natividad Medical Center at $1.5 million; Natividad lab, radiology and specialty services at $1 million; third party administrator fees at $1.6 million.

For the new pilot, Harris estimated a breakdown of $170,000 for primary care, $30,000 for pharmacy services and $30,000 for Natividad lab, radiology and specialty services, with no third party administrator. He said the costs would be shared by Natividad, the Health Department and the County.

He and Jimenez asked for the Board to direct them to further analyze costs and funding, while keeping an eye on policy changes at the state and federal level that could impact delivering services.

Supervisor Luis Alejo, who made the referral to the Board, said there is more work to be done between now and when the state budget is finalized in May to lobby for increased funding from the state to pay for health care services at the county level.

“The community has a big role to humanize this issue,” Alejo said. He urged people and organizations working with families to impart to legislators the need for health care for themselves and the community.

“This is one of those issues where we’re not going to be successful without elevating the voices of the community on this, what the health care access means to them and their children, our seniors.”

Alejo and other supervisors said they want the program to grow, but money at the county level is limited, requiring Sacramento to step in and provide additional funding.