To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Impacts of H.R. 1 and the State Changes to Medicaid Policy on the Health Services Department
?Recommendation of the County Administrator ? Recommendation of Board Committee
RECOMMENDATIONS:
1. CONSIDER accepting the report on the impacts of H.R. 1 and State changes to Medicaid policy; and
2. CONSIDER directing the Health Services Director to review and amend eligibility requirements and standards for the Basic Health Care program established by Resolution No. 2002/312; and
3. DIRECT Contra Costa Health (CCH) to return to the Board in early 2026 with proposed amendments or alternatives to the Basic Health Care program.
FISCAL IMPACT:
This informational report has no direct fiscal impacts. It reviews the fiscal and operational effects of H.R. 1 and recent Medi-Cal policy changes on CCH, highlighting challenges, priorities, and proposed actions to address adverse impacts on healthcare services.
BACKGROUND:
Signed into law on July 4, 2025, H.R. 1 introduces significant changes to Medi-Cal, including financing restrictions and eligibility barriers that will reduce federal support and make it more difficult for residents to obtain or maintain coverage. State changes further reduce eligibility and reduce reimbursement to Federally Qualified Health Centers for care provided to adults with Unsatisfactory Immigration Status (UIS).
Healthcare Coverage Loss
Estimates from the Employment and Human Services Department (EHSD) suggest that as many as 93,000 Contra Costa residents may lose Medicaid coverage by 2029.
Eligibility changes between 2026 and 2029 include asset reporting requirements, elimination of dental coverage for UIS adults, new work requirements, biannual renewals, copays, and enrollment freezes. These changes are projected to result in a loss of as many as 83,000 Contra Costa Health Plan (CCHP) members and as much as $41 million financial impact to CCHP.
Poten...
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