Date:
September 1, 2026
16
To:
Board of Supervisors
Title
Adopt a Resolution to Oppose Federal Medicaid Cuts and the Trump Administration's Withholding of Medicaid Funding Owed to California (Districts: All)
End
Overview
The Trump Administration is threatening Medicaid and the health care safety net on two fronts. First, H.R. 1, signed into law by President Trump on July 4, 2025, enacted the largest reductions to Medicaid in the program's history. The law imposes new work-reporting requirements, requires more frequent eligibility checks, restricts eligibility for certain lawfully present immigrants, and makes other significant changes to Medicaid financing. The Congressional Budget Office estimates that the Medicaid provisions alone will defund Medicaid by roughly $900 billion over ten years and increase the number of uninsured Americans by 7.5 million by 2034. In San Diego County alone, approximately 327,000 Medi-Cal recipients could be subject to the new work requirements beginning in January 2027.
This places greater pressure on counties, health care providers, and the safety-net systems that will be left to absorb the consequences when residents lose coverage or access to care.
On top of these sweeping structural cuts, the Trump Administration is separately withholding more than $2.1 billion in federal Medicaid funding payments from California, further threatening the health care safety net that serves more than 840,000 San Diegans, including approximately 280,000 children.
On May 13, 2026, the Centers for Medicare and Medicaid Services (CMS) deferred approximately $1.3 billion in federal payments across several categories of Medi-Cal spending. More than $1.1 billion of that action involved home- and community-based personal-care services. On July 21, CMS withheld an additional $867.5 million associated with the In-Home Supportive Services (IHSS) program, which helps seniors and people with disabilities remain safely in their homes rather than...
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