DURING THE second session of the Mendocino County Health Summit organized by the county, health care administrators and professionals shared what challenges in funding and patient eligibility they are preparing to face due to the  budget cuts of the One Big Beautiful Bill Act, or H.R. 1, which President Donald Trump signed into law on  July 4, 2025. The act is expected to reduce federal Medicaid spending by more than $1 trillion over the next 10 years, according to the Congressional Budget Office. 

Governor Gavin Newsom released his proposed state budget Jan. 9, which contains more cuts and policy changes to eligibility for reimbursement and funding. Between federal and state cuts — in a county with nearly half of all residents on Medi-Cal — the prospects of non-insured patients,  overloaded emergency services and higher costs seem inevitable. It remains to be seen whether the county’s emergency services and clinics are capable of weathering the storm. And the human cost is only beginning to come into focus.

Wednesday afternoon’s summit was held in the Mendocino County Board of Supervisors chambers. The supervisors asked few questions as they listened to the presentations. About a dozen audience members attended, and the presentations were—and are—available on the county’s YouTube channel. 

Emergency services could see cascade of challenges

Mendocino County Public Health Administrator Tami Bartolomei said that federal and state payments for Medicare and Medi-Cal do not cover the actual costs of service, leaving a significant reimbursement gap. This can have a large impact on the county because nearly half of county residents are insured by Medi-Cal. Bartolomei said these cuts will also impact the amount local providers are reimbursed for services.

Bartolomei referred to a June 2025 article from the Journal of Emergency Medical Services to explain cost shifting, when higher bills for private insurance subsidize losses from government programs and uninsured payments. She explained that community health systems, including 911 calls, dispatchers, emergency medical technicians, and others could become unsustainable.

“When public reimbursement rates decline or the uninsured rates rise, providers increase charges to commercial insurers that make up the difference,” Bartolomei said. “This cost-shifting dynamic erodes public trust, distorts market signals, and undermines the ability of prehospital care systems to plan and invest based on predictable funding streams. As the rate gets lower, the less they’ll be reimbursed, if at all in some cases.”

Revenue could also decline as patients opt out of carrying health insurance, reducing ambulance revenue by 15 percent or more, a figure determined by the American Ambulance Association.

New policies regarding eligibility have huge effects

As of Jan. 1, new Medi-Cal applications for undocumented adults are limited to emergency Medi-Cal only.

According to Bartolomei, loss of access to primary care is expected to cause a surge in low-acuity 911 calls, meaning there could be a higher number of 911 calls for less serious problems rather than those patients using primary care.

“Without a primary care physician, individuals tend to utilize the 911 system as their primary healthcare entry point for non-urgent or chronic conditions,” Bartolomei said.

Moreover, the reinstatement of the Medi-Cal asset limit and increased verification will create administrative workload for billing departments and likely cause coverage loss for vulnerable populations.

“Providers may see a shift payer mix as patients move from covered to self-pay, which has a historically lower collection rate. More frequent checks increase the risk of those who may experience periods where they are temporarily uninsured,” Bartolomei said. 

Jen Banks, an emergency services coordinator for Coastal Valleys EMS Agency, which contracts with Mendocino County, provided a grim forecast of possible solutions for increasing revenue and sustainability. There is no immediate fix, she said, but solutions over time might involve local tax measure proposals and pursuing federal grants.

Mendocino County Deputy Director of Social Services Rachel Eber-Elliott explained the impact of the Medi-Cal eligibility requirement changes. As of November 2025, Mendocino County had 36,628 county-administered Medi-Cal beneficiaries. About 13,000 of those residents, or about 38 percent of the county’s caseload, will be subject to the work requirements mandated in H.R. 1,  starting in 2027. And 6,000 beneficiaries will be subject to the reinstated asset limit that went into effect Jan. 1. Eber-Elliott said that the effects of the asset limit eligibility change may not be evident until the first quarterly report this year. 

Effect on in-home support could be dramatic

Mendocino County Deputy Director of Adult and Aging Services Jesse Vanvoorhis spoke about impacts to the in-home supportive services, which allows people who need caregiving to stay in their homes with in-home assistance. IHSS is a subprogram of Medi-Cal, so to qualify for IHSS, recipients must also qualify for Medi-Cal, meaning changes to Medi-Cal could affect a recipient’s ability to qualify for in-home care.

The governor’s proposed budget contains a proposal to remove what Vanvoorhis called a failsafe. Currently, when someone loses Medi-Cal eligibility, that person can still receive IHSS care until a social worker examines the case. The governor’s proposed budget would end IHSS eligibility on the same day someone’s Medi-Cal was terminated.

“There are concerns, but of course the state is looking to reduce costs. IHSS is a very costly program, but it’s important. It keeps people in their home,” Vanvoorhis said. “It’s more affordable caring for someone in their own home than having them go in a nursing home.”

Cuts with teeth

One change in H.R. 1 ends  eligibility for dental coverage for those with “unsatisfactory” immigration status, which can mean anything from violating the length of a visa or working without a permit. This change, which goes into effect July 1, comes with a cost, according to Mendocino Coast Clinics Executive Director Lucresha Renteria. Those that lose dental coverage will be put on a sliding scale at clinics with federally qualified health center status. Renteria said that for her clinics, that will mean a loss of about $200 per dental appointment.

“I don’t know how many patients that is because we don’t want to track anyone’s immigration status,” Renteria said.

Renteria also broke some bad news during the summit. She stated that the night before, the coastal clinics lost about $400,000. Its substance abuse and mental health services program funds were cancelled without warning and without a way to reinstate those funds.

“As we try to plan and look at these things, we don’t know when we’re going to get a surprise email from this administration,” Renteria said.

The summit wrapped up with county CEO Darcie Antle announcing that she is retiring from her position at the end of June. It’s unclear what impact that will have on concrete actions the county might take to address challenges that clinics, emergency providers and health care professionals will meet as budget cuts and eligibility policy changes take effect.

This story originally appeared in The Mendocino Voice.