SPEAKERS AT THE FIRST public meeting of the Mendocino County Health Summit in Ukiah grappled with changes and impacts expected from the passage of the “One Big Beautiful Bill,” signed into law July 4. The three-part summit, sponsored by county CEO Darcie Antle, is meant to explore the impact on county residents of state and federal policy changes on healthcare. The bill is expected to make cuts in federal Medicaid spending of more than a $1 trillion over the next 10 years, according to the Congressional Budget Office.
Healthcare officials from around the county gathered in the county’s Board of Supervisors chambers Wednesday last week to explore anticipated impacts on healthcare services and Medi-Cal coverage as a result of the federal bill as well as cuts to Medi-Cal by the state, many of which affect undocumented immigrants. About 10 residents who attended the workshop could write down questions to be addressed by the speakers.
Antle said that not only will lack of access to immediate primary care exacerbate treatable and preventable conditions, there will be great economic impacts on the county. Mendocino County could lose 600 healthcare jobs as a result of recent legislation, she said.
Rachel Ebel-Elliott, the county’s deputy director of social services, explained that about 42,000 individuals in Mendocino County are supported by Medi-Cal. She said that county social services administers to about 39,000 of those individuals, which means that approximately 44% of county residents use Medi-Cal services.
Ebel-Elliott said the most direct impacts to Medi-Cal and CalFresh come from the state budget cuts. Effective Jan. 1, 2026, an asset limit for determining eligibility for certain individuals will be reinstated, a limit that was removed in January 2024.
“Unfortunately, those individuals are aged, disabled households,” Ebel-Elliott said. “We had been really grateful when the asset limit requirement had been removed.”
Ebel-Elliott said the other most immediate impact from the state budget is a freeze on new Medi-Cal enrollment for applicants with unsatisfactory immigration status, a state designation that determines eligibility for benefits. Current beneficiaries will remain on Medi-Cal unless they become disenrolled due to ineligibility or failure to respond to an annual Medi-Cal renewal process, such as not filing the needed paperwork.
Another change effective July 1, 2026: dental benefits for adults with unsatisfactory immigration status will stop, including for current beneficiaries. The state budget bill also implements a provision that requires premiums for those ages 19 to 59 with UIS, which will be $30 a month.
Rod Grainger of the Mendocino Community Health Clinic said that while the state has not released data on how many Medi-Cal enrollees have unsatisfactory immigration status, the county estimates that about 9% of Medi-Cal recipients fall into this category.
One of the impacts from the federal cuts takes effect Oct 1., 2026, to the definition of a qualified noncitizen that will further reduce the number of people eligible for Medi-Cal.
Another provision from the bill takes effect Jan. 1, 2027, which adds community engagement and work requirements. Individuals ages 19 to 64 with no children under the age of 14 will be required to engage in work activities unless they merit an exemption. This population will also have to be redetermined for eligibility every six months, compared to the current annual redetermination process. In June, Mendocino County Social Services processed 2,354 redeterminations and were able to retain 95% coverage with current rules.
“With the new requirements and increased administrative burden and the reduced eligibility, the likelihood of us being able to maintain 95% continued coverage is very low,” Ebel-Elliott said.
There will also be a reduction in the retroactive coverage period for new applicants ages 19 to 64 without children under 14. There is currently a three-month retroactive period where individuals may be eligible for covered services received up to three months prior to the application date. This will change in January 2027, when that time period will be shortened to one month.
“What that really means for our health partners, there is going to be possibly a significant increase to uncovered visits,” Ebel-Elliottt said. “I think overall we are going to see a huge impact to our Medi-Cal enrollments, to the services that are covered by Medi-Cal, and individuals who are going to be dropping off of enrollment, which I think is going to be a huge impact to the overall health of our community.”
Jesse VanVoorhis, Mendocino County Department of Social Services deputy director of the adult and aging services division, spoke about the potential impacts to in-home supportive services, which provides in-home caregiving for elderly and disabled individuals. The program is 50% funded by federal Medicaid dollars.
“When funding for Medicaid is reduced, it could have the potential to reduce IHSS benefits at the state level,” VanVoorhis said.
VanVoorhis also said that all in-home supportive services recipients are Medi-Cal eligible and an increase in redetermination, as called for by the federal bill, means some people may lose benefits if they do not file paperwork on time. When someone’s Medi-Cal is discontinued, so is their IHSS.
Nate England of county health services spoke about funding cuts that have come from the California Department of Public Health via federal sources. The WIC farmers market administrative funds have been cut 70%, public health emergency preparedness decreased by 30%, hospital preparedness program by 34% and immunizations allocations received a 15% decrease.
The tuberculosis program is about 50% funded with federal dollars, which now can only be accessed through Dec. 31, cutting the program’s spending six months short of the fiscal year, which ends on June 30. The health services program receiving the biggest impact will be CalFresh Healthy Living. That program, which offers education in healthy eating and obesity prevention among other initiatives, will shut down in April 2026.
“The program implements integrated programs and activities to influence healthy behaviors by sharing tips on healthy eating and exercising,” England said. “This program is in the community to make healthy living simple and sustainable.”
Tami Bartlomei said that while emergency medical services are not directly called out in the state or federal bills, it could see an impact from the federal bill’s redetermination requirements, which could increase the number of uninsured persons needing ambulance service. This could cause ambulance service providers to see a decrease in revenue of 15% or more, according to PWW Advising Group, an EMS consulting firm.
As for behavioral health, for which Medi-Cal provides the primary funding, Dr. Jenine Miller of health services expects an increase in untreated conditions as well as homelessness and a weakened overdose prevention as well as decreased crisis response. Dr. Miller said there could also be a reduction in school-based mental health services.
“It’s so important to make sure our kids that are going to school, and all kids, are getting the level of care they need for mental health and substance use treatment,” Dr. Miller said.
England listed the public health expectations from recent legislation.
“Overall poorer health outcomes,” England said. “Creating health inequities, increase in death, loss of healthcare and strain on the healthcare system. Isolate underserved communities and reduced disaster preparedness and outbreak response. An increase in food insecurity, homelessness and chronic disease as well as slowed disease detection and weakened surveillance.”
Jeff Mock, chief operating officer for North Coast Network Adventist Health, said 35% to 38% of patients who come to the emergency departments of the three Adventist Health hospitals are Medi-Cal patients. Those who lose their benefits will not be turned away, but the hospital may not get the reimbursement.
Mock also addressed a report that was released before the federal bill was passed that included a list of hospitals that could close as a result. Mock said that the list was created by looking at which hospitals serve a lot of Medicare and Medi-Cal patients, and that 75% to 80% of Adventist’s hospitals patients are supported by either service. Adventist Health Ukiah Valley was on the list, in addition to Adventist Health St. Helena, in Napa County.
“That’s why we fell on that list,” Mock said. “Adventist Health is not closing our doors.”
Wednesday’s workshop was part one of a three-part series. The second summit will take place in January, and the third next spring.
This story originally appeared in The Mendocino Voice.