As Congress proposes cuts to elements of Medicaid and California navigates tightening its budget, San Mateo County Health is reiterating its commitment to serving the county’s most vulnerable populations who are already experiencing high health disparities.
While it may be too early to know the specific impacts on county programs, nearly 20% of county residents rely on public insurance and County Health to provide safety-net medical and behavioral health care, underlining the significance of the ongoing finical discussions, Chief of Health Colleen Chawla said.
“Funding and eligibility changes to these programs will be not only disruptive but painful to families, children, older adults and the disabled, the unhoused — everyone for whom public services are a lifeline,” Chawla said.
Cuts to Medicaid would ultimately mean a reduction of care for low-income people and families in our county, and will possibly reduce the number of providers who want to serve Medi-Cal patients, Chawla said. Changes to how service providers are paid have already led to fiscal turmoil and organizations ceasing operations.
“Reducing Medicaid funding that safety net health care providers receive just adds additional barriers to care by making the provision of care in the medical program not financially viable,” Chawla said.
For the last year, low-income undocumented immigrants have been eligible for Medi-Cal, able to use the services offered by County Health.
However, Gov. Gavin Newsom announced Wednesday he is proposing to freeze such eligibility for the state’s health insurance. He also proposed that those whose immigration status would not make them eligible for federal Medicaid should pay a monthly premium starting in 2027. The proposals could save the state $5.4 billion, the governor’s office said.
The governor’s proposal comes as the Trump administration proposes major spending reductions to Medicaid, including penalizing states that provide insurance for undocumented immigrants by reducing federal funding.
Although threatening, if federal funding is reduced, Chawla noted that it would only be a fraction of County Health’s budget, and the degree to which the public health agency would be affected remains to be seen. For now, Chawla assured County Health will continue to provide services to as many residents as needed.
“Nothing has changed as of now,” Chawla said. “We still have the funding we have, we still have the responsibilities we have. I don’t want everyone who is doing the work to be distracted by all the noise.”
A service that remains viable, and will continue to be, is San Mateo County’s Access and Care for Everyone, a low-cost health coverage option for low-income residents who are not eligible for Medicare or Medi-Cal or other insurance policies. As Medi-Cal eligibility may change, County Health will watch the ACE program as more people may seek the service, Chawla said.
As budgets continue to be finalized and the federal bill travels through the legislative process, Chawla said she is not having her staff spend too much time nitpicking the specifics of every proposal, and every change.
“It’s not the best use of our staff time if it is just going to change in the next day,” Chawla said. “That doesn’t mean we’re not paying attention, it means we’re watching it closely and we’re being judicious on how we use our resources to estimate what the impacts might be.”
With every change, County Health will continue to prioritize the people it serves and strives to “meet fiscal challenges with creativity and resolve.”
“We provide really important safety net services and if we have to think about how to implement reductions or changes in policy, it is going to be without residents, patients, clients at the center,” Chawla said.
(1) comment
Ms. Chawla - perhaps it is time to apply some means testing. "nearly 20% of county residents rely on public insurance and County Health". Don't tell me that all 150,000 (=20%) are truly eligible but may have found a way to weasel themselves and their families into this largesse? You must be aware that many local practicing MDs are also into this scam and found an easy way to make a buck. We need a DOGE effort in this County, at every level to stamp out fraud and waste! Then, we will have a balanced budget and the Weiner/Papan crowd can stop tearing up.
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