COUNTY LEADERS PROACTIVELY PLAN FOR MEDICAID CHANGES WITH SAFETY-NET REFORM
SAN DIEGO, CA – (March 3, 2026) Today, the San Diego County Board of Supervisors approved a sweeping effort to modernize the County Medical Services (CMS) program to prepare for impending federal healthcare cuts and protect access to care for medically indigent residents.
The action, introduced by Chair Terra Lawson-Remer and Vice Chair Monica Montgomery Steppe, comes in response to H.R. 1, the “One Big Beautiful Bill Act,” which reduces Medicaid funding nationwide, tightens eligibility rules, and increases redetermination requirements beginning January 1, 2027. Hundreds of thousands of low-income San Diegans are projected to lose Medi-Cal coverage as a result, leading to increased reliance on emergency rooms and millions of dollars in additional uncompensated care costs for local hospitals.
“We know massive healthcare cuts are coming,” said Chair Lawson-Remer. “We know hospitals will feel the strain. And we know residents will suffer because of Trump’s Medicaid cuts if we don’t modernize our safety net. We’re not going to let that happen without preparing.”
Under California law, counties must serve as the healthcare providers of last resort for medically indigent residents. Unlike other large counties, San Diego does not operate a public hospital system and instead contracts with community clinics, hospitals, and physicians to fulfill this obligation. However, San Diego’s CMS program is currently the most restrictive program of its kind among large counties in California.
“Our antiquated CMS system is not a badge of pride,” said Vice Chair Montgomery Steppe. “At a time when more residents are losing coverage, we cannot afford outdated rules and unnecessary barriers. Today’s action ensures we are rebuilding a system that is equitable, accessible, and responsive.”
CMS has not been comprehensively updated since the Affordable Care Act expanded Medi-Cal and reduced demand for county indigent care programs. With projected coverage losses ahead, the Board’s action positions the County to proactively evaluate and reform CMS before demand surges.
The approved proposal will task the Board’s Ad Hoc Subcommittee on Social Safety Net and Behavioral Health Systems Transformation to work in collaboration with stakeholders and develop reform recommendations, including:
- Revising restrictive eligibility standards such as income thresholds, age limits, and the ‘immediate and long-term need’ requirement
- Eliminating lien requirements and reforming property limits
- Expanding phone and virtual application options
- Reviewing covered services
- Evaluating the impact of cost-sharing requirements on patient access
- Assessing fiscal impacts of modernizing the program
The proposal also requires monthly engagement with regional healthcare providers to ensure reforms reflect frontline realities and fiscal sustainability. A formal update on budget implications and proposed adjustments will be delivered within 60 days following adoption of the FY 2026–27 budget.
“This action sends a clear message,” Vice Chair Montgomery Steppe added. “San Diego County will meet its legal and moral obligation to serve as the safety net provider of last resort.”
Chair Lawson-Remer also added, “We cannot control how the federal landscape keeps shifting, but we can control how we respond. Today, we are signaling that our local government will be here to help our most vulnerable.”
