San Mateo County braces for Medi-Cal and food stamp cuts

According to recent county presentation data Jan. 27, an estimated 36,000 to 53,700 individuals — about 20% to 30% of those on Medi-Cal in the county — could lose medical coverage due to a mix of factors, ranging from having undocumented immigration status or failing to submit more robust paperwork to satisfy work requirements. About 20,000 county residents on Medi-Cal are undocumented, however, that number is a rough estimate.

Between fiscal year 2027 — which begins this July — and 2028, the county’s health department is expected to lose roughly $45 million as a result of the federal changes.

Some of the eligibility changes for undocumented immigrants have already gone into effect as of Jan. 1. For instance, no new enrollees without satisfactory immigration status can receive full Medi-Cal coverage and even adults who have been enrolled may only be able to receive pregnancy or emergency-related care.

Immigration enforcement has been a focal point for the current federal administration, which has pushed for lowering access and availability to social safety net programs and medical care. Over the past several months, San Mateo, Redwood City and the county have pursued lawsuits challenging the legality of imposing certain requirements — including those related to immigration status — on key social safety net programs.

Claire Cunningham, director of the San Mateo County Human Services Agency, said that while some of the most significant cuts won’t start until after the midterm elections, the county is still prepping for major funding changes.

“H.R. 1 represents the most significant federal change to the safety net in decades,” Cunningham said. “While our immediate fiscal exposure is limited, the operational and programmatic impacts are substantial and will grow if the state does not backfill lost federal revenue.”

The cuts and additional administrative requirements put more pressure on the county’s Access to Care for Everyone program. The local program is not technically an insurance policy, but it helps cover medical costs for those who are low-income and do not qualify for other state or federal insurance programs, regardless of immigration status. Enrollment in the program decreased as of a few years ago when Medi-Cal eligibility expanded. But now, county officials say they expect significant demand placed on the program in the near future, introducing new fiscal considerations. Shifting patients from Medi-Cal to ACE will cost the county about $4 million for every 1,000 new enrollees, according to data from the Jan. 27 presentation.

The cuts also impact recipients of CalFresh, the state’s food stamp program, as new work requirements and additional changes go into effect this year. Starting in April, even some noncitizens that are here lawfully, including refugees, will not be eligible for it, affecting roughly 1,000 recipients in the county. About 3,700 county recipients will be eligible for work requirements starting in June.

“H.R. 1’s cuts to CalFresh administrative funding by about $2.6 million also happens at the same time as workload demands are increasing significantly,” Cunningham said.

While the ACE program can help some of the county’s most vulnerable residents, it’s unclear how much the county can financially step in as the cuts go into effect. Much of that decision depends on the degree to which state funds can sufficiently supplement the programs.

“We’re talking about people going hungry and people — our residents, our neighbors — unable to access health care and life-saving medication,” Supervisor Noelia Corzo said. “It is not lost on me that this is yet another impact we are having to shoulder in our community, just like every community across the country.”