H.R. 1 will have significant fiscal impacts on counties and the California communities we serve. Counties will incur new costs to provide indigent health care to individuals who lose Medi-Cal coverage, and additional workforce costs to implement the eligibility requirements of H.R. 1, including Medi-Cal and CalFresh. For indigent care programs across all 58 counties, costs are anticipated to range from $2 billion to $5.5 billion per year. The total anticipated annual costs are anticipated to be $6 billion – $9.5 billion, which includes indigent care, impacts on county hospitals, and workforce costs to implement eligibility requirements.
RCRC worked closely with CSAC, UCC, CMSP, and county affiliate organizations to develop details about the county impact of H.R. 1. On February 4, 2026, CSAC along with county organizations released the H.R. 1 Impacts fact sheet and a press release. This release marks the beginning of a comprehensive effort to emphasize the severity of H.R. 1’s impact on counties, and how it threatens the level of all services that counties provide. RCRC is working closely with CSAC and county organizations to develop a budget request to address the direct county costs associated with H.R. 1 impacts.
For additional information, contact RCRC Senior Policy Advocate, Sarah Dukett.