To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Health Services Basic Healthcare Update
Recommendation: Recommendation of the County Administrator
RECOMMENDATIONS:
CONSIDER accepting the report on the Basic Health Care Program; CONSIDER approving the recommended changes to the Basic Health Care Program; and DIRECT the Health Services Director to amend eligibility requirements and standards for the Basic Health Care program established by Resolution No. 2002-312.
FISCAL IMPACT:
The Basic Health Care (BHC) Program is a county-funded program providing care at Contra Costa Health (CCH) facilities. At a projected enrollment of 6,000 patients, the Basic Health Care (BHC) program would cost approximately $13.5 million annually. Of this amount, $7.5 million reflects services Contra Costa Regional Medical Center (CCRMC) already provides and therefore does not require additional funding. The remaining $6.0 million represents the estimated annual funding required to support program operations and services.
BACKGROUND:
The Basic Health Care Program originated in 1982 as the Basic Adult Care Program, created in response to the State of California's elimination of the Medi-Cal Medically Indigent Adult Program.
• In 2002, the program was renamed the Basic Health Care (BHC) Program and restructured to provide health care services to uninsured Contra Costa County residents who lacked access to other coverage options.
• In 2009, the County amended BHC eligibility requirements to include a legal permanent residency requirement, thereby excluding undocumented residents from program participation.
• From 2015 through 2023, the Contra Costa CARES Program provided primary care services to uninsured immigrant adults through community clinics. Following California's 2024 expansion of full-scope Medi-Cal eligibility, CARES was discontinued. The program's final evaluation identified a continuing need for health care access options for uninsured residents who are not eligible for other coverage.
• In April 2024, the Board accepted the Healthcare Options Workgroup report and directed Contra Costa Health to remove the legal residency requirement from the BHC Program and expand income eligibility to 139-300 percent of the Federal Poverty Level.
• In October 2024, the Board authorized continued Measure X funding through Aliados Health to support a community clinic-based coverage model comparable to BHC, commonly referred to as CARES 2.0.
Current Program
The BHC Program is a county healthcare access program that covers care at Contra Costa Health facilities for low-income residents who have no other coverage options. It is not health insurance - it works only inside the county health system and covers a defined list of services. Anyone eligible for Medi-Cal, Covered California, or employer-sponsored coverage is not eligible for BHC, and applicants must apply for every coverage program available to them.
Why the Board is Being Asked to Act Now
On December 16, 2025, the Board received a presentation from CCH on the effects of House of Representatives Bill 1 (H.R. 1) and state policy changes on healthcare coverage and financing. That presentation identified the following key drivers requiring action:
• H.R. 1 changes to Medi-Cal impose financing restrictions that strip billions in federal support and create eligibility and access barriers that will make it more difficult for people to get or stay covered.
• State changes to Medi-Cal reduce eligibility, particularly for adults with Unsatisfactory Immigration Status (UIS), and reduce reimbursement to Federally Qualified Health Centers for care provided to the adult UIS population.
• EHSD estimated that as many as 93,000 people in Contra Costa County will be subject to the new rules and may lose Medi-Cal coverage.
• The County is obligated under Welfare and Institutions Code Section 17000 to serve as the provider of "last resort" for indigent Californians who have no other means of support.
The Board directed CCH to review and amend eligibility requirements and standards for the Basic Health Care program under Resolution 2002-312 in response to H.R. 1 and state Medi-Cal changes, and to return with proposed amendments or alternatives in 2026.
Analysis
Federal and state policy changes are expected to increase the number of Contra Costa residents who lose health coverage, creating greater demand for safety-net services. The BHC Program helps fill this gap by providing access to essential health care and reducing reliance on avoidable emergency care.
To prepare for these changes, Contra Costa Health (CCH), in partnership with community stakeholders, has been redesigning the BHC Program since June 2026, evaluating costs, operations, demand, and eligibility requirements. The proposed redesign is intended to ensure BHC remains a sustainable and effective access program for residents who lose other health coverage.
Conclusion
Directing the Health Services Director to amend the eligibility requirements and standards for the Basic Health Care Program under Resolution No. 2002-312 will allow CCH to respond to the significant and anticipated increase in uninsured residents resulting from H.R. 1 and state Medi-Cal changes. This action is consistent with the Board's December 2025 direction.
CONSEQUENCE OF NEGATIVE ACTION:
Without these changes, the County may be unable to effectively address anticipated growth in the uninsured population or maintain access to critical safety-net services. As uninsured residents are projected to reach 93,000 by 2031 and 47,500 Medi-Cal members transition to fee-for-service in 2027, updated BHC eligibility standards are essential to preserving coverage for those who lose insurance.
CHILDREN’S IMPACT STATEMENT:
The recommendation supports the following children's outcomes: Children and Youth Healthy and Preparing for Productive Adulthood; Families that are Economically Self Sufficient; Families that are Safe, Stable and Nurturing; and Communities that are Safe and Provide a High Quality of Life for Children and Families.