County Leaders Warn of Lasting Safety Net Impacts at H.R. 1 Budget Hearing

County leaders are delivering a stark warning to state lawmakers: H.R. 1’s sweeping cuts will fundamentally disrupt California’s safety net and strain county governments for years to come.

“Counties are not able to address these impacts on our own,” Tulare County Administrative Officer Jason Britt testified Thursday at a California Senate Budget Subcommittee hearing.  “A true partnership over a multi-year period with the state is needed to prevent our safety net from crumbling.” Britt was one of several county panelists who described how sweeping federal changes to Medi-Cal and CalFresh will impact county budgets and the state services that counties provide in local communities.

Counties are now forced between a rock and a hard place – at the center of implementing H.R. 1 while absorbing both increased demand and significant new costs.

County officials from across the state outlined these impacts during panel testimony, including:

• Jackie Contreras, Director, Los Angeles County Department of Public Social Services
• Jorge Orozco, Chief Executive Officer, Los Angeles General Medical Center
• James Williams, County Executive, Santa Clara County
• Jason Britt, County Administrative Officer, Tulare County
• Gilbert Ramos, Assistant Executive Officer, San Bernardino County

They were joined by frontline voices highlighting implementation challenges:

• Christopher Palma, Eligibility Worker, Ventura County
• Tangerine Brigham, Chief Operating and Strategy Officer, San Francisco Health Network
• Corinne Sanchez, Chief Executive Officer, El Proyecto del Barrio

Together, panelists emphasized that H.R. 1’s impacts will be felt across the full safety net, from eligibility systems to hospitals and community providers.

At full implementation, H.R. 1 could shift cost counties up to $9.5 billion annually. That’s driven by rising indigent care demand, reduced federal funding for public hospitals, and expanded eligibility and administrative requirements.

Counties anticipate a surge in uninsured residents, resulting in unprecedented pressure on indigent care programs – the providers of last resort.

Britt highlighted that counties will be forced to cover rising indigent health care costs with limited public health funding and county general funds. “To the extent county general funds are used, it will come at the expense of other critical services like Sheriff and Fire,” he said.

The Legislative Analyst’s Office underscored the scale of the challenge. Its report submitted at the hearing explains how “counties are unlikely to have the resources required to meet the increased indigent health care demand without new, additional means of support.”

Panelists also described how new Medi-Cal and CalFresh work requirements and more frequent eligibility redeterminations will reduce access to coverage and food assistance benefits. The result is increased administrative workload for counties that will strain already stretched eligibility systems. Reductions in federal financing for public hospitals further threaten the stability of the broader safety net and impact care for all Californians, not just those who lose coverage.

The hearing reinforced that H.R. 1 represents a structural challenge for California’s budget, not a one-year issue. For counties, addressing these impacts will require a sustained, multi-year partnership with the state to protect access to care and services and to ensure the safety net remains intact. “I recognize you have a daunting task ahead of you,” said Britt. “Please know the counties stand ready to be a willing partner to explore the best solutions for all.”