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Date: |
October 27, 2026 |
21 |
Title
Authorize a Safety Net Bridge Pilot Program to Address Anticipated Gaps in Services for Residents Disenrolled from Benefit Programs (Districts: All)
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Overview
Under new federal and State guidelines from House Resolution 1 (H.R. 1), many San Diego County residents may face reduced or lost CalFresh and Medi-Cal benefits, leading to a growing gap in access to food, continuity of primary care, and access to prescription medication. Based on local Medi-Cal enrollment data and projections from the California Department of Health Care Services, it is estimated that beginning in March 2027, 68,761 of the 309,939 San Diego County Medi-Cal recipients subject to new work and community engagement requirements will be at risk of losing Medi-Cal coverage. The County of San Diego (County) does not currently provide primary care, limiting its ability to serve as a fully integrated safety net without new investments or partnerships.
On November 4, 2025 (12), the San Diego County Board of Supervisors (Board) directed the Chief Administrative Officer (CAO) to explore opportunities to establish a Safety Net Bridge program. This program would provide no-cost primary care medical services, same-day prescription medication, and access to fresh food to address anticipated gaps in services due to shifts in federal and state policy. In response, County staff conducted a preliminary Safety Net Bridge Feasibility Analysis and shared the results to the Board via a memorandum on February 5, 2026, which included an assessment of the anticipated impacts of H.R. 1, an analysis of existing County and community resources, a summary of received community input, and potential options to support San Diego County residents who may become or have been disenrolled from benefit programs.
On March 24, 2026 (27), the Board received the Safety Net Bridge Feasibility Analysis Report and authorized the CAO to develop an implementation plan for a pilot program and to report back with plans and cost estimates within 45 days for the food access component and to return within 180 days for the primary care medical services component. On May 15, 2026, staff reported back to the Board via a memorandum outlining actions the Board could take to implement the food access component. Subsequently, on June 25, 2026 (12), the Board authorized the CAO to implement emergency food distribution events and benefit enrollment assistance services for one year, through a partnership with two food banks and County facilities to create a pipeline of services for families most impacted by CalFresh eligibility changes.
The Safety Net Bridge pilot program will help maintain continuity of care and services for San Diego County’s most vulnerable residents as new Medi-Cal policies take effect. A countywide approach is needed because limiting the pilot to targeted ZIP codes would create access barriers that are avoided by expanding the pilot. While services will be available countywide, the intent is to focus resources within communities that are most impacted by new H.R. 1 requirements. By proactively educating and assisting individuals with navigating requirements, the program will help families maintain their benefits and access to essential food and medical care. For those who lose healthcare coverage, the program will partner with primary care providers to deliver short-term primary care medical services to ensure continuity of care. The Safety Net Bridge pilot program aligns with the broader County strategy to strengthen the safety net amidst federal and State policy changes through proactive customer service, advocacy, technology solutions, workforce readiness, and community partnerships.
Today's item requests the Board authorize implementation of the 12-month Safety Net Bridge pilot program to support primary care medical services, with expenditures not to exceed $20.425 million, including funding for primary care services, same-day no-cost prescription medications, community health fairs, Community Health Workers to provide Medi-Cal and CalFresh education and navigation, and County staff administration. Additionally, today’s item requests the transfer of $17.545 million in appropriations and requests the Board authorize competitive solicitations for medical providers for primary care services and Community Health Worker services to provide Medi-Cal education and navigation services. Today’s action also directs the CAO to report back with a mid-point progress report on the Safety Net Bridge pilot program results and return within twelve months with a preliminary data report to inform continued pilot status and authorize the CAO to apply for future funding opportunities.
This item supports the County’s vision of a just, sustainable, and resilient future for all, with particular attention on communities in San Diego County that have been historically under-resourced, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. By maintaining benefits enrollment and ensuring continued access to critical health care resources, the Safety Net Bridge pilot program will prevent gaps in care that can lead to severe health events requiring emergency care.
Body
Recommendation by Chief Administrative Officer:
1) Authorize the Chief Administrative Officer (CAO), or designee, to implement a 12-month pilot to support the primary care medical services component of the Safety Net Bridge program to serve San Diego County residents 19-64 years-old, who meet Medi-Cal eligibility criteria but may temporarily have a gap in coverage due to new requirements not to exceed $20,425,000 to be allocated as follows:
a. $12,400,000 to fund primary care medical services, access to same-day no-cost prescription medications, and linkages to social services, including agreements with primary care providers who serve Medi-Cal patients identified through the competitive procurement process;
b. $750,000 to fund expansion of community health fair events to provide primary care medical services and enrollment assistance in neighborhoods and places where people gather;
c. $6,600,000 to provide dedicated staff support for Medi-Cal and CalFresh education and navigation services to help people keep their benefits and to support re-enrollment if benefits are lost. This includes:
i. $700,000 for County Community Health Workers to support food distribution sites, Live Well on Wheels events, and other Safety Net Bridge program activities across the county.
ii. $5,900,000 to competitively procure contracts with local, community-based organizations to provide Medi-Cal education and navigation outreach in high-impact areas using a Community Health Worker approach.
d. $675,000 for County staff administration of the pilot, including data analysis, communication and outreach, coordination, and payment.
2) Transfer appropriations of $17,600,000 from Finance Other, Services & Supplies, to Health and Human Services Agency, Clinical and Safety Net Coordination Division.
3) In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting to issue a competitive solicitation for primary care providers who serve Medi-Cal patients most likely impacted by H.R. 1 requirements, and upon successful negotiations and determination of a fair and reasonable price, award contracts for an initial term of one year, with four option years and up to an additional six months if needed, and to amend the contracts as needed to reflect changes to services and funding, subject to the approval of the Deputy Chief Administrative Officer, Health and Human Services Agency.
4) In accordance with Section 401, Article XXIII of the County Administrative Code, authorize the Director, Department of Purchasing and Contracting to issue a competitive solicitation for Community Health Workers to provide Medi-Cal education and navigation, and upon successful negotiations and determination of a fair and reasonable price, award a contract for a term of one year, with four option years, and up to an additional six months if needed, and to amend the contract as needed to reflect changes to services and funding, subject to the approval of the Deputy Chief Administrative Officer, Health and Human Services Agency.
5) Direct the CAO, or designee, to report back to the Board with a mid-point progress report on the Safety Net Bridge pilot results and return at or before twelve months with a preliminary data report to inform continued pilot status beyond its scheduled end date.
6) Authorize the CAO, or designee, to apply for and accept funding opportunities to support strategies that strengthen the safety net.
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Equity Impact Statement
On January 1, 2027, changes to Medi-Cal resulting from federal bill House Resolution 1 (H.R. 1) will take effect. An estimated 309,939 San Diego County residents may be subject to new work and community engagement requirements, of whom an estimated 68,761 will be at risk of losing coverage. Residents who are most at risk of losing Medi-Cal coverage are disproportionately low-income households and people of color. This action advances equity by prioritizing services for residents who have lost benefits, communities most impacted by food insecurity, and populations historically underserved by the health system. The Safety Net Bridge pilot program provides options to maintain access to critical health care resources and strengthen social service supports for residents impacted by changes in federal and State policy. While the Safety Net Bridge pilot program will be available countywide, the intent is to focus resources within the communities that are most impacted. The pilot will remain flexible to direct resources toward high-impact communities where residents are expected to be most affected by Medi-Cal changes. The Safety Net Bridge pilot program shows the County’s commitment to help offset some of the burden of federal and State funding cuts.
Sustainability Impact Statement
This item supports the County of San Diego (County) Sustainability Goal #1 to engage the community in meaningful ways; Sustainability Goal #2 to provide just and equitable access to County services; and Sustainability Goal #4 to protect the health and well-being of everyone in the region. Specifically, the Safety Net Bridge pilot program provides the opportunity to maintain access to critical health care resources and strengthen social service supports for residents in the region who are impacted by federal and State policy changes.
Fiscal Impact
Funds for this request are included in Finance Other and Health and Human Services Agency in the Fiscal Year (FY) 2026-28 Operational Plan. If approved, this request will result in estimated one-time costs and revenue of approximately $7 million in FY 2026-27 and $13.4 million in FY 2027-28 to implement a Safety Net Bridge pilot program for twelve months to provide primary medical care, medications, linkages to social services; expand community health fairs; and deliver Medi-Cal education and navigation to support continuity of care and keep people connected to their benefits. The funding sources for Recommendations 1a-c include $17.6 million in one-time use of Unlocked Reserves appropriated for safety net services and $2.15 million in one-time social services administrative revenue for the Medi-Cal program. Staff will continue to explore additional program revenue opportunities to help offset the use of Unlocked Reserves to the extent possible. The funding sources for Recommendation 1d include existing General Purpose Revenue, Realignment, Medi-Cal Administrative Activities (MAA), and social services administrative revenue, estimated at $0.675 million, for existing County staff to provide pilot administrative support. This action reduces the safety net services balance of funds in Finance Other to $25.1 million remaining to be allocated. There will be no additional staff years.
Business Impact Statement
N/A
Advisory Board Statement
This item was presented as an informational item to the Health Services Advisory Board on October 13, 2026, with representatives in attendance from the Social Services Advisory Board and the Healthy San Diego Consumer and Professional Advisory Board.
Background
Under House Resolution 1 (H.R. 1) and new State guidelines, many San Diego County residents may face reduced or lost CalFresh and Medi-Cal benefits, leading to a growing gap in access to food, continuity of primary care, and access to prescription medication. Based on June Medi-Cal enrollment and projections from the California Department of Health Care Services, County staff anticipate that 68,761 of the 309,939 San Diego County Medi-Cal recipients subject to the new work requirements will be at risk of losing coverage. The County of San Diego (County) does not currently provide primary care, limiting its ability to serve as a fully integrated safety net without new investments or partnerships.
On November 4, 2025 (12), the San Diego County Board of Supervisors (Board) directed the Chief Administrative Officer (CAO) to explore opportunities to establish a Safety Net Bridge program that would provide no-cost primary care medical services with access to same-day prescription medication free-of-charge, and access to fresh food to address anticipated gaps in services due to federal policy changes. The overall goal of the Safety Net Bridge program is to keep recipients connected to their benefits, such as Medi-Cal and CalFresh, mitigate potential gaps in coverage, and provide a range of customizable options tailored to individual community needs and available resources.
On February 5, 2026, County staff provided a memorandum with a preliminary feasibility analysis that detailed six potential options to support residents disenrolled from benefit programs based on an assessment of existing resources and community input. Several options were provided, varying according to scope, cost, infrastructure requirements, and implementation timeline. All options included the delivery of primary care, assistance with benefits re-enrollment, and access to medications and food.
On March 24, 2026 (27), the Board received the Safety Net Bridge Feasibility Analysis Report and authorized the CAO to develop an implementation plan for a pilot program and to report back with plans and cost estimates within 45 days for the food access component of the program and to return back within 180 days for the primary care medical services component. On May 15, 2026, staff reported back to the Board via a memorandum outlining actions the Board could take to implement the food access component. On June 25, 2026 (12), the Board authorized the CAO to implement emergency food distribution events and benefit enrollment assistance services for one year, in partnership with two food banks and County facilities to create a pipeline of services for families most impacted by CalFresh eligibility changes.
Safety Net Bridge Pilot Program - Primary Care Medical Services Component
County staff developed a data-driven implementation plan for the Safety Net Bridge pilot program that will support essential services to prevent vulnerable residents from losing their Medi-Cal coverage and will help offset costs for providers to deliver short-term primary care medical services to individuals who lose coverage while they complete requirements to enroll or re-enroll in Medi-Cal. These services will be delivered by primary care providers who serve Medi-Cal patients and are selected through a competitive solicitation process. These actions align with the broader County strategy to strengthen the safety net amidst federal and State policy changes through proactive customer service, advocacy, technology solutions, workforce readiness, and strong community partnerships.
Focus Population & Geographic Area for Service Delivery
The focus population includes San Diego County residents 19-64 years-old, who meet Medi-Cal eligibility criteria but may temporarily have a gap in coverage due to new requirements. This includes those who have been disenrolled from Medi-Cal coverage due to H.R. 1 work and community engagement requirements and those undergoing a benefit renewal delay. A countywide approach is needed to maintain continuity of care and services for San Diego County’s most vulnerable residents; limiting the pilot to targeted ZIP codes would create access barriers that are avoided by expanding the pilot. While the Safety Net Bridge pilot program will be available countywide, it is designed to prioritize communities most affected by Medi-Cal changes.
Stakeholder Engagement
Community feedback from stakeholders was gathered through various avenues such as the Health Services Advisory Board, the Healthy San Diego Consumer and Professional Advisory Committee, the Social Services Advisory Board, the Behavioral Health Advisory Board, the African American Clinical Advisory Committee, and the Commission on the Status of Women and Girls. Stakeholder feedback informed the need to expand provider options to include trusted primary care providers who serve the focus population to allow people to remain with their trusted providers and ensure continuity of care. Input received through a Request for Information process emphasized the importance of maintaining patient connections to their medical home, noting that many conditions still require in-person evaluation, with telehealth and mobile services used as extensions of care rather than replacements for in-person visits. Additional provider input indicated strong support for expanding the pilot program to ensure countywide accessibility. Feedback from providers and community groups highlighted the need for additional on-site Medi-Cal enrollment support and to expand community health fair capacity so residents can access resources in trusted locations where they routinely gather. Providing resources for Medi-Cal and CalFresh education, navigation, and enrollment assistance in the community will help prevent gaps in coverage. Education and navigation services will leverage the unique role and expertise of the County’s Community Health Workers (CHWs) and amplify those efforts with contracted, community-based CHWs to ensure that trusted community messengers are resourced to continue bridging communication gaps and serving those communities most in need.
Approach and Service Delivery Options
Based on Board direction and community input, County staff developed a pilot approach with service delivery options to support those most likely to be impacted by H.R. 1 changes. The approach includes contracting with primary care providers who serve Medi-Cal patients for short-term primary care, access to same-day no-cost medications, and linkages to social services; expanding community health fair events that offer medical care and resources; and utilizing CHWs to provide Medi-Cal education and navigation in the community and clinical settings to help individuals complete Medi-Cal and CalFresh applications and required documentation.
Primary care services - If approved, the County will contract with primary care providers, such as Community Health Centers and Independent Provider Organizations, to help offset their costs to deliver short-term primary care services, including preventive services, chronic disease management, diagnostic services, specialist referrals, and same-day no-cost prescription medications to individuals who may experience a gap in their Medi-Cal coverage. Providers will also facilitate linkages to social services like food, housing, Medi-Cal and CalFresh application assistance, the 211 WorkReady Hub, and transportation. Primary care services will be provided for up to 90 days per patient, with potential for a 90-day extension under certain circumstances. Multiple delivery options will be available to ensure access to services based on individual needs and preferences, including: 1) in-person visits at provider sites, 2) telehealth visits conducted through video or phone visits, and 3) Mobile Medical Units (MMU) operated at community health fairs, outreach events, and other trusted community locations. Implementation steps will include execution of contracts for a total amount of $12.4M with primary care providers capable of serving Medi-Cal patients and supporting program goals. Following contract execution, providers will deliver care across approved service delivery modalities to ensure timely access and continuity of services.
Community health fairs - Building on successful local models, capacity will be expanded to sustain and support community health fair events that provide primary care, enrollment assistance for CalFresh and Medi-Cal, food assistance, and other resources at trusted neighborhood locations. These events will be coordinated with the primary care service providers to serve people without a medical home. Implementation steps include execution of agreements in the amount of $750,000 with community health fair providers with demonstrated ability to reach highly impacted populations and experience with planning and coordinating event operations. Events sites will be selected based on community needs, logistical requirements, and operational needs. A targeted outreach approach will be developed to promote service offerings and maximize patient primary care appointment utilization.
Medi-Cal and CalFresh education, navigation, and enrollment assistance - Education, navigation, and enrollment assistance will help to ensure successful Medi-Cal and CalFresh enrollment. This support includes dedicated County Community Health Workers (CHWs) to support food distribution sites, Live Well on Wheels events, and other Safety Net Bridge program activities throughout the county. Additionally, contracted CHWs will provide education and navigation to prevent people from losing their Medi-Cal coverage. CHWs will be embedded in the community to provide outreach through text messages and phone calls and will provide in-person education and navigation to those who need extra help staying enrolled in Medi-Cal or regaining their coverage if they have been disenrolled from Medi-Cal. Implementation steps include execution of contracts in the amount of $5.9M with community-based organizations capable of providing CHW services and ability to manage administrative functions such as fiscal oversight, data collection, staff training and supervision.
Communication
Coordinated communication and outreach will be necessary to ensure general awareness of resources and continued access to care for those impacted by the new H.R. 1 requirements. The communication plan will emphasize consistent messaging, coordinated outreach, and clear guidance for individuals experiencing temporary Medi-Cal gaps. It will describe available services, eligibility criteria, primary care locations and scheduling options, and how to get support with Medi-Cal and CalFresh enrollment. Communication channels will include a dedicated County webpage, QR codes, flyers, social media announcements and reminders, and partner-based outreach to ensure timely, accessible information for impacted communities in all County threshold languages, including for individuals who may not have access to on-line information. Additional information for providers seeking to become Medi-Cal providers will be available. The communication plan will be finalized following completion of the procurement process to ensure that contractor details, contractual terms, and stakeholder roles are fully established before defining messaging and communication channels.
Monitoring
Ongoing monitoring of the pilot will provide critical data about the feasibility and potential for expansion or scaling of the primary care medical services component of the Safety Net Bridge program. Contracts with primary care medical providers will include data and reporting requirements to be submitted monthly. These metrics will include population demographics, service utilization such as number of medical visits, same-day prescription medications received, linkages to social services, cost breakdown for administrative and operational need, and outcomes, such as number of emergency department visits potentially avoided and reenrollment in benefits, including as CalFresh and Medi-Cal. Additionally, voluntary patient satisfaction surveys will be administered to patients after each primary care visit to determine quality of care by contracted providers.
Next Steps
Pilot findings will inform the expansion and refinement of the primary care medical services component of the Safety Net Bridge pilot program. A report back to the Board with a mid-point progress update on pilot results will provide early insights into program performance and operational adjustments. A subsequent return to the Board within twelve months will present preliminary data to guide decisions regarding continuation of the pilot beyond the one-year pilot period. Longer term decisions and partnerships will depend on available funding, policy guidance, and identified community needs.
Today’s action requests that the Board authorize the transfer of $20,425,000 for the Safety Net Bridge program for a twelve-month pilot to ensure San Diego residents remain enrolled in benefits and have access to primary care medical services. This includes $12,400,000 for Medi-Cal providers to help offset their costs to deliver primary care medical services, $750,000 for the expansion of community health fair events, $6,600,000 for Medi-Cal and CalFresh education and navigation to help people keep their benefits and to support re-enrollment if benefits are lost, and $675,000 for administrative costs. Additionally, today’s action requests that the Board authorize competitive solicitations for the Safety Net Bridge pilot program to include contracts with medical providers for primary care services and contracts for Community Health Worker services to provide Medi-Cal education and navigation services. Today’s action would also direct the CAO to report back with a mid-point progress report on the Safety Net Bridge pilot program results and return within twelve months with a preliminary data report to inform continued pilot status and authorize the CAO to apply for future funding opportunities.
Linkage To The County Of San Diego Strategic Plan
This action supports the County of San Diego 2026-2031 Strategic Plan initiatives of Community (Quality of Life) and Equity (Health) by ensuring access for all to health and social services, providing services that enhance the community’s well-being, and ensuring the capability to respond to the needs of individuals in the community.
Respectfully submitted,
Ebony N. Shelton
Chief Administrative Officer
Attachment(s)
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