March 25, 2026 - Sacramento, CA — California county leaders are releasing a multi-year state budget request to the Governor and Legislature to protect our safety net from the federal government’s cuts to local communities.

H.R. 1 shifts billions in ongoing costs for health care, food assistance, and other safety net programs from the federal government to states and counties. California counties estimate the impact at up to $9.5 billion per year — making it one of the largest structural challenges facing the state budget in decades.

Counties are putting forward a clear, coordinated and responsible solution: a multi-year state partnership with a $1.9 billion investment in the upcoming budget (Fiscal Year 26-27), and $4.5 billion the following year (FY 27-28).

This measured response, developed through months of collaboration with county associations representing elected leaders, department heads and staff, is the minimum needed to prevent widespread disruption to essential services.

Unless the state acts, H.R. 1’s cuts will demolish California’s safety net and force cuts to critical local services:

• Californians who turn to counties after losing their health coverage will not get the care they need.
• Every public hospital system patient will feel the pain.
• Counties face major new costs to verify eligibility for Medi-Cal and CalFresh recipients
• Behavioral health systems will face increased demand.

The impacts will not stop there. If the state forces counties to absorb H.R. 1’s cuts alone, there will be no choice but to cut core services that communities rely on every day: public safety, homelessness programs, election administration and more.

For the sake of millions of Californians, it’s imperative that the Governor’s updated “May Revision” budget proposal directly support counties in addressing this crisis.

What county leaders are saying:

• Santa Clara County Supervisor Susan Ellenberg, California State Association of Counties (CSAC) President: “H.R. 1 fundamentally destabilizes California’s safety net by shifting billions in new costs to counties that are already stretched thin, putting hundreds of thousands of residents at risk of losing care. Without immediate and sustained state partnership, the state’s safety net will shatter and every service counties provide will be harmed.”
• Mariposa County Supervisor Miles Menetrey, Rural County Representatives of California (RCRC) Chair: “Coverage losses under H.R. 1 will significantly increase pressure on county systems that are already stretched thin, particularly in rural areas where provider capacity and funding are more limited. An immediate, coordinated partnership between the state and counties is essential to address these growing demands. Targeted investments are necessary to sustain care for vulnerable populations, stabilize local systems, and prevent broader disruptions to essential public services.”
• Sacramento County Supervisor Rich Desmond, Urban Counties of California (UCC) Chair: “H.R. 1 represents a fundamental restructuring of the federal-state-county partnership for provision of safety-net services, with consequences that urban counties cannot absorb without significant policy and fiscal mitigation. We urgently need the Governor and the Legislature to invest resources to shore up the foundation of safety net services to support low-income Californians.”
• Glenn County CAO Scott De Moss, California Association of County Executives (CACE) President: “H.R. 1’s changes will leave many Californians with no coverage while county resources are stretched thinner to meet state‑mandated obligations. That will leave fewer dollars for public safety, elections, and other core community services. A true multi‑year partnership with the state is essential to rebuild indigent care programs, protect public hospital systems, and ensure our local safety net does not crumble beyond repair.”
• Michelle Gibbons, County Health Executives Association of California (CHEAC) Executive Director: “County indigent care programs are not equipped to absorb a surge of uninsured patients. These programs provide basic, subsistence-level services – not comprehensive care – and without a renewed state-local partnership, counties will struggle to meet even that core obligation. Without action, counties will be forced to stretch limited resources further, putting pressure on other safety-net services. Protecting Medi-Cal coverage remains the most effective way to prevent these impacts, alongside renewed state investment in county indigent care infrastructure and services.”
• Kari Brownstein, County Medical Services Program (CMSP) Executive Director: “Many of the nearly 125,000 CMSP county residents that lose Medi-Cal due to H.R.1 will seek critical health care services from CMSP. Without ongoing state financial support, CMSP will not be able to meet these essential needs.”
• Erica Murray, California Association of Public Hospitals and Health Systems (CAPH) President & CEO: “The devastating hit from H.R. 1 at the local level cannot be overstated nor overlooked. We must all work together to preserve access to care.”
• Carlos Marquez III, County Welfare Directors Association of California (CWDA) Executive Director: “Counties are deeply committed to keeping as many people as possible connected to CalFresh and Medi-Cal in the face of H.R. 1, and doing our part to reduce explosive future costs associated with hunger and uncompensated care. But absent additional State investment, preventable losses in coverage and benefits will ensue for otherwise perfectly eligible low-income Californians. There’s still time to keep people connected to our safety net, let’s not let this opportunity to pass us by.”
• Michelle Cabrera, County Behavioral Health Directors Association of California (CBHDA) Executive Director – “Although most individuals with behavioral health needs will be exempt from work requirements, the confusion about eligibility and the significant administrative barriers contained in HR1 will have their intended effect, which is to force tens of thousands of existing clients off of Medi-Cal covered mental health and substance use disorder benefits. Without additional investment, those individuals and many more, will destabilize and wind up in an inhumane cycle of homelessness, substance use, and criminal justice involvement.”
  
  Source: California State Association of Counties (CSAC)