Trump's 'big, beautiful' bill will mean decreased access to health care and increased costs to the county.

The Monterey County Board of Supervisors requested a report on what impact President Donald Trump’s “One Big Beautiful Bill” would have on the county and its residents and the news they heard on Tuesday, Sept. 30, was not at all beautiful—possibly 22 percent of residents, approximately 38,000, are estimated to lose Medi-Cal, the state’s version of Medicaid, over the next four years.

Other residents will lose access, or have limited access, to CalFresh, the state’s version of the Supplemental Nutrition Assistance Program formerly known as food stamps. In addition, the bill, also known as HR 1, will mean cuts to federal funding to the county and increased costs to provide health care through the county’s clinic and hospital, Natividad.

The supervisors, looking grim, were concerned that the cuts will mean poor health outcomes and greater health care expenses for residents who are already living on the margins, as well as negatively impacting the financial health of Natividad and the county itself.

“This is so messed up,” Supervisor Kate Daniels said, immediately after the heads of the departments of Social Services and Health, and the CEO of Natividad shared their report.

Supervisor Wendy Root Askew, stating that 70 percent of mothers and 50 percent of the overall population are on Medi-Cal, added that she believes the cuts will have a greater impact on Monterey County than other counties.

“Our goal and our need is to ensure that everyone can continue to get their care but the reality is not everyone is going to continue to get their care,” Root Askew said. “The reality is dire, the reality is stark.”

She reaffirmed the county’s commitment to care for as many residents as possible, but said “this is a life-or-death situation, this is a state of emergency for our low income residents and our residents who rely on Medicaid.”

Changes to Medi-Cal that will unfold in 2026 through 2028 include a reinstatement of a Medi-Cal asset limit for households with those 65 years of age or older, disabled, or living in a nursing home, possibly impacting more than 13,220 residents, according to Roderick Franks, director of Social Services. That goes into effect Jan. 1, 2026.

Over 61,000 will have to go through eligibility redeterminations every six months instead of annually, which could result in some getting kicked off of Medi-Cal rolls.

Co-pays for many of those who were part of the Medi-Cal expansion which provided access to health care to low income individuals regardless of immigration status will go up starting July 1, 2028.

The estimated number of those considered to have “unsatisfactory immigration status” that could potentially lose Medi-Cal benefits is nearly 39,000, Franks said.

In addition, work requirements are being added to Medi-Cal expansion members, under the Affordable Care Act, for non-disabled and adults between the ages of 19-64, starting in 2027. They must verify 80 hours of employment, volunteer work, education or job training, impacting possibly over 34,000 residents.

Calfresh recipients identified as “able-bodied adults without dependents” will have similar work requirements to follow beginning Jan. 1, 2026, expected to impact more than 8,700 adults up to age 64. (The previous age limit was 54.) Rodericks said he expects nearly 1,500 people without homes will lose eligibility for Calfresh under the new rules.

Director of Health Services Elsa Jimenez said the bill will result in the elimination of the Calfresh Healthy Living Program, about $750,000 in funding, which educates individuals and schools and elsewhere about nutrition and access to food, as well as the elimination of Teen Pregnancy Prevention programming, about $500,000 in funding lost.

Cuts by the state of California will also impact those considered to have unsatisfactory immigration status, with no new enrollees accepted beginning Jan. 1.

In a change that will impact the county’s budget, beginning July 1, 2026, for those considered UIS who receive care at one of the county’s 12 clinics, the county will be reimbursed by “fee for service amount only,” instead of under the current prospective payment system. As an example, Jimenez said that the fee for service amounts range between $60 to $140 per visit. The current system reimburses between $230 to $580 per visit.

Jimenez said about 23 percent of clinic patients have UIS status. That would result in a significant cut in reimbursement funds to the clinic system.

Dr. Chad Harris, CEO of Natividad, reported that there is still uncertainty ahead for public hospitals. One source of funding called Disproportionate Share Hospital Funding, about $14 million a year for Natividad, is currently in limbo due to the government shutdown. A decision had yet to be made on whether that funding would continue.

It was also not clear whether Natividad would be eligible for funds under a federal plan to provide funds for rural hospitals, he said. Natividad has not been classified as such, but Monterey County is considered a rural county. “We are watching it closely,” Harris said.

However, what’s known as the Federal Medical Assistance Percentage, which assists hospitals that receive large numbers of Medicaid and uninsured patients, is going to drop beginning Oct. 1, 2026. Reimbursement for emergency care for undocumented adults under the Affordable Care Act expansion will drop from 90 percent reimbursement to 50 percent, he said.

Funding cuts over time to all California public hospitals and health care systems beginning in 2028 are estimated to cost $4 billion, he said.

He reminded supervisors that the first public hospital in the state of California was established in Monterey County in 1844. The county official launched a hospital in 1886.

“We’ve been here for 139 years and I know everyone supports us being here for at least another 139 years, supporting our mission, but I do acknowledge and know there will be some tough decisions as we look forward,” he said.

Supervisor Glenn Church responded that he was concerned for the overall financial health of Natividad first, and the county second.

Supervisor Chris Lopez said he had encountered immigrant residents confused over the changes to Medi-Cal, who thought they were already going to lose their care. In fact, anyone who already has Medi-Cal will continue to have it, as long as they meet the new requirements to maintain it. Those considered UIS age 19 and above will not be eligible to apply beginning Jan. 1. (Those 18 and younger are eligible.)

That led Supervisor Luis Alejo to ask if the agencies could spend the next few months getting the word out to dispel any confusion and encourage people to apply before Jan. 1. The supervisors will consider allotting $250,000 for the effort at a meeting on Oct. 14.