Monterey County health officials warn of harm to public health from H.R. 1 Trump’s budget will reduce eligibility for Medi-Cal and CalFresh recipients.

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By George B. Sánchez-Tello

Monterey County health officials gathered in early May to broadcast a warning to residents about the impact of pending changes to public healthcare and food aid under H.R. 1, a federal funding law the Trump Administration has dubbed the One, Big, Beautiful, Bill Act.

The presentation, available on the county’s YouTube channel, follows alarms across the county, state and country of potential harm from narrowed healthcare access and food aid.

“It really is unraveling the great strides that have been made at the federal and state level with trying to ensure our low-income residents have access to healthcare services,” said Elsa Jimenez, director of the Monterey County Health Department.

Jimenez joined Roderick Franks, director of Monterey County Social Services, Chad Harris, chief executive office of Natividad Medical Center, and Nicholas Pasculli of the county’s communications bureau for the Zoom presentation and internet broadcast.

The major changes to both healthcare and food aid include work or community service requirements for individuals, the group shared. Medi-Cal and CalFresh recipients will also have to reapply twice a year for services instead of the current annual reenrollment.

The new work and service requirements put a burden on patients and county providers to prove eligibility, they said, requiring more work from county employees and patients likely having to wait longer for certification.  

There are approximately 175,000 Medi-Cal recipients in Monterey County, said Franks, and their health services cost more than $50 million a month.

Medi-Cal is California’s public health insurance program funded by the state and federal government. Eligible recipients must earn less than 138% of the federal poverty level; for an individual, that’s $21,597 or less annually. 

Work requirements will start in 2027 for people on Medicaid or Medi-Cal, Franks said. “We estimate that number in the county of Monterey to be about 50,000 people that will be subject to those new work and community engagement requirements.”

Thousands may likely no longer qualify, he warned. 

“We’re anticipating between 12,500 and 19,000 people of that group will ultimately lose their benefits for being non-compliant with that new work and community engagement requirement,” Franks said. 

CalFresh is part of federal food aid known as Supplemental Nutritional Assistance Program, or SNAP. 

Individuals and households with incomes at or below 200% of the federal poverty level can qualify for CalFresh, Franks said, or about 50,000 people in Monterey County. “Of those 50,000 people, over half are actually children that are receiving food support.” 

H.R. 1 will require CalFresh recipients to prove they worked 80 hours a month, earn at least $580 monthly or have done at least 80 hours a month of volunteer community service, Franks explained. Approximately 37 percent of county households receiving CalFresh are working, Franks added. County officials estimate about 8,700 CalFresh recipients will be subject to the new requirement. 

Prior to passage of H.R. 1, there were already work requirements for food aid — but with certain exemptions. Now those groups, including veterans, adults as old as 64, unhoused individuals, youth aging out of foster care, and parents of teenagers will have to show proof of work, according to the Center for Health Care Strategies, a policy design and implementation think tank for public healthcare.  

Monterey County received a waiver from the federal government because of its high unemployment rate — 10%, according to the state, Franks said, and will implement new work requirements in October, while other parts of the country will implement those changes in June. 

Healthcare programs for extremely low-income, or indigent, patients are also facing cutbacks, the three noted. 

California counties have been required to provide healthcare for indigent residents since 1933, Harris explained. After the passage of the Affordable Care Act, known as Obamacare, responsibility shifted to the state of California. But now that responsibility will shift back to counties, Harris said — without funding. 

Monterey County health officials are also bracing for changes in funding for undocumented residents who qualify for health insurance through the state. Starting July 1, medical service providers will receive less reimbursement and there are no additional funds to make up the loss. 

There will also be delays in contract tracing and containing communicable diseases, like tuberculosis, Monkeypox, syphilis and HIV, Jimenez warned. 

The healthcare officials all noted that the loss of preventive care — like regular prescriptions and medical appointments — can lead to long-term health emergencies, known as the downstream effect. If patients lose access to prescription drugs for chronic illnesses like diabetes or high blood pressure, what was once a manageable diagnosis can become more dangerous.  

Franks, Harris and Jimenez stressed that Medi-Cal and CalFresh recipients should not assume they lost their health insurance and should contact their healthcare providers if they have questions.

Jimenez said the Central California Alliance for Health recently granted funding to community organizations to spread information on changes to Medi-Cal and CalFresh, and to help recipients re-enroll and retain their health insurance and food aid. 

Natividad Chief Executive Officer Chad Harris said patients should continue to go to the doctor, keep their appointments and maintain their prescriptions. 

“I just want to remind folks: Still come see us. Make sure you are getting your healthcare needs taken care of,” Harris said. “At the end of the day, it’s better for the patient, it’s better for their families and it’s better for the community.”

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