There are 18,000 Medi-Cal and CalFresh recipients in San Joaquin County subject to expanded work requirements.

Overall, there are 314,058 county residents enrolled in Medi-Cal and 131,891 residents enrolled in CalFresh out of San Joaquin County’s overall population of 812,000 people.

That was just one of the numerous highlights the San Joaquin County Board of Supervisors received last week in an oral report from County Administration and Health and Human Services leadership outlining the estimated local impacts of H.R.1, known as the “One Big Beautiful Bill Act,” signed into law on July 4, 2025.

 H.R.1 is a federal budget measure addressing taxation, healthcare, and social services safety net programs.

Based on preliminary review, San Joaquin County estimates an annual revenue drop ranging from $50.9 million to $76.9 million.

“Counties across our region are already seeing the effects of H.R.1, and San Joaquin County is not waiting to react,” said Supervisor Rickman. “I asked our departments to immediately assess the financial impact and identify exactly where we stand. Fiscal responsibility and transparency aren’t talking points — they are the standard.”

“We are laying out the numbers so the public clearly understands what’s changing, where funding originates, and what it means for the services people depend on.”

 The County presented the following fiscal impact checklist to clarify revenue changes, funding sources, and associated mandates:

*Medi-Cal revenue reductions, estimated annual income loss: $30.4 million to $34.4 million.

Counties must administer eligibility and ensure access to indigent health services

There are work requirements and more frequent eligibility reviews.

* San Joaquin General Hospital estimated annual income loss: $11 million to $30.8 million.

The cuts include reduction in federal match for certain emergency services populations. State directed payments will be capped and reduced annually until aligned with Medicare rates.

*SJ Health Clinics, estimated annual income loss: $5 million to $9 million

An estimated 85 percent of patients are enrolled in Medi-Cal.

There is a projected 10 to 15 percent disenrollment driven by work requirement and eligibility changes. That will result in a loss of reimbursable visits and increased uncompensated care.  

* Behavioral Health Services estimated income loss: $22.5 million.

There is a significant projected Medi-Cal revenue reduction that will result in an increase in uninsured population by an estimated 35 percent.

*Public Health Services.

 CalFresh SNAP Program income loss: $1.2 million.

It impacts residents previously covered by Medi-Cal coverage, estimated uninsured population to rise by 35%.

Coverage for 4,000 children with complex medical conditions will be county’s responsibility if federal funding is reduced.

* Human Services Agency Medi-Cal Administration estimated income loss: $4.6 million CalFresh Administration estimated income loss: $2.0 million with estimated increased Costs: $2.7 million. Counties must determine eligibility and implement new federal work and documentation requirements

* In-Home Supportive Services.

There has been a 60.4 percent caseload growth over five years with decreased administration funding per case (down 19.7% in 5 years).

Potential penalties tied to reassessment timelines and hours per case estimated resources needed/cost increase is $110,000 to $2.4 million annually, depending on state baseline determinations  

The County’s review indicates that H.R.1 does not eliminate service demand.

Instead, it shifts fiscal and operational responsibility to local government.

Counties are required to continue administering eligibility, public health, hospital, behavioral health, and safety net services even as federal revenue sources decline or change.

 The Board of Supervisors has directed staff to continue refining impact estimates and to engage State and federal partners regarding fiscal relief options, including revenue restoration, cost sharing adjustments, mandate flexibility, or implementation modifications.

“As we head into the next budget cycle, the Board and our County team are focused on practical solutions,” Supervisor Rickman continued. “We are tightening spending where necessary, protecting essential services, and demanding greater efficiency across county government.”

“Tough economic conditions require discipline and clear leadership — and we are meeting that challenge head-on.”