As we look ahead to the potential implications of the One Big Beautiful Bill Act (H.R. 1), it is essential that we begin preparing now. Funding cuts, combined with work requirements for non-disabled Medicaid enrollees, an increase in the frequency of eligibility redeterminations, restricted eligibility for some immigrant groups, and tightened rules around provider taxes and state-directed payments, will require us to re-engage familiar strategies, adopt new ones, and strengthen our efforts to safeguard coverage for the most vulnerable residents of San Diego and Imperial counties.
Given the likelihood that people will lose coverage, we need to consider solutions to ensure people have access to health care before an issue becomes life-threatening. Under California Welfare and Institutions Code Section 17000, counties have an obligation to serve as the provider of last resort for residents who do not qualify for Medi-Cal. County Medical Services Program (CMSP) in Imperial County and County Medical Services (CMS) in San Diego County are two programs that fund medical care for uninsured adult residents. While CMS and CMSP are not health insurance and only cover certain medical services, they are programs of last resort for eligible adults aged 21-64. Both CMSP and CMS use a network of local hospitals, community health centers, and private physicians to provide care to those who need it.
However, the programs in both San Diego and Imperial counties have essentially been unfunded for years and it will take serious planning to get them up to full strength. In San Diego County, the planning is just getting started. A Board of Supervisors letter was submitted last week that directs a comprehensive, iterative review of CMS — with a particular focus on eligibility, enrollment, covered services, and delivery models — and requires that this work be conducted in coordination with and reported through the Ad Hoc Subcommittee on Social Safety Net and Behavioral Health Systems Transformation. This was submitted as a late agenda item by Chair Terra Lawson-Remer and Vice Chair Monica Montgomery Steppe, because they believe immediate board direction is necessary to prepare the county to adapt quickly and effectively to protect the health of San Diegans.
At Tuesday’s meeting, the San Diego County Board of Supervisors voted 4-1 to move forward on overhauling its CMS program. Our team is already engaged in conversations, educating staff on the program — bringing our knowledge of and insight into this antiquated program and what it will take to make sure it is accessible for all who need it.
Taking into consideration all the changes that will happen with Medi-Cal, programs like this will be vital as we move forward, especially given that neither San Diego nor Imperial counties have a county hospital. You know all too well that when an uninsured person needs care, it’s your hospitals where they end up. And while CMS currently has just three people enrolled, those numbers are bound to go up. This is especially true if you factor in that in recent years, 150,000 San Diegans have left the Medi-Cal rolls — but we know they haven’t left San Diego.
Stay tuned for more as we ramp up our education and advocacy efforts. This is only the start of the conversation, which will be ongoing over the next several months, and is essential as we navigate challenges and identify practical solutions together. By working together and leveraging our resources, we can help protect access to care for those most at risk in our region.