For all the recent discussion about the pending financial implications of last year’s One Big Beautiful Bill Act, the consequences are becoming very real as changes to CalFresh eligibility take effect, placing basic nutrition and health at risk for thousands in San Diego and Imperial counties.
The immediate ramifications of the federal legislation, which extend beyond health care financing into safety-net programs that directly impact people, will shape a patient’s health long before they arrive at a hospital’s doors. Starting today — April 1 — many individuals and families may face new barriers to accessing food assistance, placing additional strain on already vulnerable communities.
The changes taking effect will eliminate CalFresh eligibility for many lawfully present immigrants, including those seeking asylum and refugees. Additional impacted groups include survivors of trafficking, battered noncitizens, and certain individuals with special immigrant visas or humanitarian parole statuses. More information is available in these FAQS from the California Department of Social Services.
Already, more than 1 in 4 people in San Diego County is nutrition insecure, meaning they experience the inability to provide three, nutritious meals per day for themselves and/or their families with their own income.And those numbers are only expected to grow: the San Diego Hunger Coalition estimates that somewhere between 13,000 San Diegans may lose access to CalFresh with today’s changes.
Food insecurity is an ongoing health-related stressor that was identified in HASD&IC’s 2025 Community Health Needs Assessment. Of the two specific financial burdens mentioned most frequently by the community, food was one of them.
“We’re having a rough time accessing food sometimes … and I can’t even imagine putting myself in the shoes of our clients that … have to say, well, I have to drive the kids to school, but then I also have to feed them, so let me figure out what our priorities are,” said one CHNA focus group participant.
Food prices across the U.S. have risen substantially over the past several years. In 2023, the cost of a home-cooked meal in San Diego was $3.64, surpassing the maximum CalFresh benefit of $2.83 per meal by 29%. This means that even when families receive this benefit to help cover the cost of food, it isn’t enough. Now, even fewer people will be receiving assistance.
Imperial County faces some of the most significant economic and food access challenges in California. The region consistently has among of the highest unemployment rates in the state, often reaching double digits and far exceeding state and national averages, while nearly 1 in 5 residents lives below the poverty line. These economic realities translate directly into food insecurity: Imperial County has the highest rate in California, with roughly 1 in 5 residents — and an even greater share of children — lacking consistent access to enough nutritious food.
This is not just theoretical. Food insecurity is something that your hospitals see firsthand every day. It worsens chronic conditions, drives avoidable emergency visits, and undermines recovery, making nutrition access a core health issue, not a peripheral one.
Unfortunately, this is just the first of many changes to our social safety net that is coming down the pipeline. Starting June 1, there will be annual recertification for enrollees, along with CalFresh work requirements for able-bodied adults without dependents (ABAWDs). Based on December 2025 enrollment, San Diego County staff estimate that approximately 93,500 individuals will be subject to the ABAWD work requirement during the first year of implementation. This will be followed by cost-sharing for CalFresh beneficiaries beginning Oct. 1. Medi-Cal eligibility shifts are also underway — an enrollment freeze for those with non-satisfactory immigration status took effect on Jan. 1, with more changes to continue through 2027.
The consequences from these shifts in policy will not be abstract or distant — they will surface in clinics, emergency departments, and hospital beds across the state. As trusted community anchors, hospitals have an essential role to play in helping patients understand and navigate these changes, connecting them to available resources, and advocating for policies that support health beyond the hospital walls. Helping ensure patients can meet their basic needs is not separate from your mission — it is fundamental to it.