County leaders warn HR 1 could strip hundreds of millions from local health system

County and health‑plan leaders told the Ventura County Board of Supervisors that federal legislation branded HR 1 could sharply reduce Medicaid (Medi‑Cal) funding, imperil supplemental state‑directed hospital payments and increase uncompensated care, producing a large multi‑year fiscal shortfall for county healthcare operations.

Dr. Felix Nunez, CEO of Gold Coast Health Plan, told the board the plan provides coverage for roughly 240,000 county residents and reinvests hundreds of millions into local providers; he warned HR 1 would reduce federal matching funds, limit enrollment and "undermine our county's healthcare systems and infrastructure." He said California could lose roughly $30 billion a year in Medicaid and federal funds if current federal proposals stand.

County CFO Scott Powers and assistant CFO Mark Sewell presented modeling that projected a phased, multi‑year reduction in Medicaid‑related revenues and other federal programs with cumulative impacts in the hundreds of millions. Sewell presented scenarios where continuing the status quo would require unsustainable general‑fund support and potentially force reductions in services, deferral of capital needs and reassignment or layoffs.

Board members pressed staff on assumptions, how other counties are preparing and whether state or federal fixes are likely. Executives said the county is coordinating with other California urban counties and federal and state delegations to press for guidance and potential mitigation, but acknowledged high uncertainty and the need to assume HR 1 as a working baseline for near‑term budget planning.

The board voted to receive and file the first‑quarter budget update and to direct staff to submit backfill allocation reports and recommended adjustments; supervisors emphasized advocacy and asked staff to return with mid‑year updates as guidance and numbers evolve.

Why it matters: Ventura County's safety net and public hospital system rely heavily on Medi‑Cal and related state/federal funding. The county’s staff said the fiscal effects could ripple into public health, social services and housing supports, and would force difficult decisions if federal policy is implemented as currently drafted.