As California prepares for significant changes to Medi-Cal eligibility and coverage beginning Jan. 1, 2027, hospitals and health systems must be ready for the challenges ahead. Even before many of H.R. 1’s key provisions take effect, our region is already experiencing substantial coverage losses. Over 200,000 people in San Diego County and more than 3,000 in Imperial County no longer have coverage through Medi-Cal.
The question is: How many more will follow?
While the extent of future coverage losses remains uncertain, the consequences are clear. People who lose coverage face greater barriers to accessing care, managing chronic conditions, and receiving preventive services. Reducing coverage does not eliminate the need for care. Patients may delay treatment until their conditions worsen, turning to already overburdened emergency departments and hospitals that must absorb increased demand and additional uncompensated care.
California counties have a statutory responsibility under Section 17000 of the Welfare and Institutions Code to provide care for qualifying low-income residents who lack other sources of support. Neither San Diego County nor Imperial County operates a county-run hospital. Hospitals and health systems across our region therefore play a central role in the safety net for residents who are uninsured, underinsured, or unable to pay for care.
San Diego County’s County Medical Services (CMS) program is currently so restrictive that only four people are enrolled. After months of coordinated advocacy by HASD&IC, health systems, and community partners, the Board of Supervisors is poised to make historic changes to the program. On Oct. 27, the Board will consider nearly a dozen recommendations to eliminate the lien requirement, simplify the enrollment process, improve program administration, increase affordability, and more closely align the CMS program with Medi-Cal patient protections.
These initial actions represent a major milestone, but significant work remains to translate the CMS program reforms into access to care for San Diegans who need it most. As enrollment grows, HASD&IC will continue to identify barriers to enrollment and needed health care services and advocate for additional policy changes as needed.
Imperial County participates in the County Medical Services Program (CMSP), that serves residents in 35 predominantly rural California counties. On Oct. 5, the CMSP Governing Board approved deeply concerning cuts that will take effect Jan. 1, 2027. These changes include limiting undocumented residents to emergency-only coverage; lowering the income eligibility ceiling to 200% of the federal poverty level; reducing asset limits for individuals and couples; and eliminating several covered benefits, including outpatient substance use disorder treatment, expanded mental health services, and certain vision, audiology, and dental services.
HASD&IC staff joined dozens of advocates from across the state in public testimony at the CMSP Governing Board meeting to express concern about the consequences for patients and the financial sustainability of hospitals serving these low-income and rural communities. These reductions will further weaken access to care at a time when more residents may need to rely on the county safety net.
With less than three months before the next Medi-Cal changes take effect, our collective advocacy is more important than ever. HASD&IC remains committed to working alongside hospitals, health systems, counties, and community partners to protect coverage and strengthen access to care for residents of San Diego and Imperial counties.