DATE:
March 3, 2026
17
TO:
Board of Supervisors
SUBJECT
Title
Body
EXPLORING REFORMS TO COUNTY MEDICAL SERVICES AND WAIVE BOARD POLICY A-72 (DISTRICTS: ALL)
OVERVIEW
San Diego County is at a critical inflection point in the evolution of our safety net health systems. Federal changes under H.R. 1, coupled with related State implementation actions beginning in 2026, are expected to increase healthcare coverage loss and administrative barriers for residents enrolled in Medi-Cal and other public programs.
As eligibility standards tighten and redetermination requirements expand, more San Diegans are likely to experience temporary or long-term gaps in healthcare coverage. While many large California counties operate public hospital systems as part of their safety net infrastructure, San Diego County does not. Instead, our region fulfills our statutory requirement as emergency provider of last resort by contracting with community clinics, hospitals, and physicians to provide medically indigent care. In the absence of a county-operated system, San Diego relies on hospitals and community clinics to provide the full continuum of emergency, hospital, and outpatient care services for all residents regardless of their ability to pay. When coverage reimbursement is unavailable, hospitals often absorb significant uncompensated costs.
While recent County efforts have focused on mitigating short-term coverage disruptions, this item seeks to address the County's separate and ongoing statutory obligation to serve as the provider of last resort for residents who do not qualify for Medi-Cal. These responsibilities are distinct but complementary. While short-term stabilizing bridge efforts aim to prevent individuals from falling through temporary administrative gaps, County Medical Services (CMS) must serve as a durable safety net option for those who are excluded from coverage altogether.
Given the County's size, demographic diversity, and this distinct delivery structu...
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