Title
Receive update and authorize Chair of the Board to sign letters of support for CSAC proposal for State funding request to mitigate impacts of HR1
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive an update on the potential fiscal and programmatic impacts of H.R.?1: Protect California’s Safety Net legislation on county-administered health and human services; and,
b. Provide direction to staff regarding legislative advocacy and proposed state-county funding partnerships.
SUMMARY
H.R.?1, as proposed, would restructure federal funding for major safety-net programs and shift up to $9.5?billion annually in costs to California and its counties. The measure expands eligibility verification and work requirements for Medi-Cal and public assistance programs, while reducing federal cost-sharing mechanisms that currently stabilize county health and hospital systems.
Without state partnership or federal amendments, counties would face significant unfunded mandates in indigent health care, public hospital operations, and human services administration. Notably, this is a two-year request.
DISCUSSION:
The California State Association of Counties (CSAC) has identified H.R.?1 as the most consequential fiscal challenge to counties in decades. Under the proposed legislation:
Health Coverage Impacts:
· Approximately 1.5?million Californians could lose Medi-Cal coverage due to imposed work requirements.
· Counties remain legally obligated to provide basic indigent care under Welfare and Institutions Code?§17000, despite the state withdrawing local funding for that mandate following the 2013 Medi-Cal expansion.
· Elimination of federal Medi-Cal supplemental financing tools is expected to reduce funding to public hospitals statewide by billions of dollars, especially impacting rural and safety-net providers.
Administrative and Fiscal Impacts:
· New federal eligibility verification requirements would create hundreds of millions in additiona...
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