Contra Costa County is closely monitoring the impacts of the 2025 federal and state policy changes, including federal reconciliation bill (H.R. 1), which includes major cuts to Medicaid (Medi-Cal) and SNAP (CalFresh) and imposes more strict eligibility criteria for each program.
These changes pass along unfunded costs to the County, increase administrative workload, and will result in reduced access to healthcare services and food assistance for thousands of residents.
The County administers the Contra Costa Health Plan (CCHP) serving about 270,000 people, along with the public hospital and nine community clinics. New eligibility rules could affect roughly half of all Medi-Cal enrollees and may result in a loss of coverage for as many as 93,000 Contra Costa residents by 2029.
Medi-Cal Eligibility Changes:
Federal and state cuts to healthcare services will result in a number of specific changes.
In 2026
- On January 1, 2026, undocumented adults 19 and older will no longer be able to enroll in full-scope Medi-Cal.
- On July 1, 2026, the adult UIS population will no longer have coverage for state dental services
- On October 1, 2026, the UIS population will begin to include populations such as refugees, asylees and other non-citizens currently separate from existing UIS population, resulting in a loss of coverage for these populations.
In future years:
Estimated Fiscal Impacts
Contra Costa County has already lost about $24 million this fiscal year due to funding cuts and new unfunded responsibilities. Future Medi-Cal changes result in projected annual losses to the County of about $307 million, per year, by fiscal year 2028-29. This is at a time when public hospitals, clinics, and health plans across the state face higher demand with fewer resources.
Key drivers include:
- $159 million due to disenrollment in Medi-Cal due to federal and state changes to eligibility
- $148 million due to loss of supplemental state and federal healthcare funding for the current Medi-Cal population
Contra Costa County remains committed to protecting core services, monitoring the impacts of H.R. 1, and keeping the community informed. Key dates include:
- Dec. 16, 2025 – Health Services Department presentation of H.R. 1 and State Changes to Healthcare Policy
- Feb. 3, 2026 – Annual Board Retreat
- Apr. 27–28, 2026 – Annual Budget Hearing
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