Rules Committee advances Tyler Sadwith to full Senate after questions on Medi-Cal access and hospital finances

Tyler Sadwith, the governor27s nominee for chief deputy director for health care programs at the California Department of Health Care Services (DHCS), told the Senate Rules Committee that his priorities are safeguarding access and equity in Medi-Cal and continuing the CalAIM transformation of the program.

Sadwith, who introduced himself as the nominee, said he would focus first on "safeguarding access and equity as we navigate a changing federal landscape," and second on "continuing the transformation of Medi-Cal through CalAIM and the transformation of California's behavioral health system." He said the program serves "14,000,000 Californians" and described the work as deeply personal because of family members who rely on services.

Why it matters: Members pressed Sadwith on immediate financial pressures facing hospitals and the impact of recent federal changes. Sen. Laird and others asked what steps DHCS can take to prevent avoidable closures and to expedite payments to struggling facilities. Sadwith described a multi-pronged approach that includes closer coordination with managed-care plans, expedited adjudication of fee-for-service claims, and compressing timelines for state-directed payments to help hospital cash flow.

On federal changes and coverage risk, Sadwith said his office is preparing for eligibility shifts tied to H.R. 1 and other changes. "We are estimating at full implementation that work requirements may lead to up to 1,400,000 Medi-Cal members losing coverage," he told the committee, and that "up to 400,000 Medi-Cal members may lose coverage as a result of the 6-month redeterminations." He said DHCS has been developing a strategy since the law was signed to minimize disenrollments, working with counties and managed-care plans.

Committee members also raised program integrity and transparency. Sen. Jones asked whether DHCS should resume publishing a Medi-Cal fraud control report; Sadwith said he would look into why the report was discontinued and pledged to consider restoring transparency. Senators asked about audits, oversight, and whether anti-fraud activities continue; Sadwith said the audits and investigations team represents roughly 15% of department staff and that measures to combat fraud, waste and abuse remain in place.

On access to dental care and maternal services, Sadwith described CalAIM initiatives that expand community supports (including medically tailored meals and enhanced care management) and efforts to bring new provider types into Medi-Cal, add loan repayment incentives and test managed-care models that integrate dental benefits.

Public support and outcome: Representatives of provider groups and local agencies—CalPACE, the California State Association of Counties, the District Hospital Leadership Forum, PARATEAM, the California Association of Public Hospitals and others—spoke in support of Sadwith27s confirmation, citing his stakeholder engagement and experience with behavioral-health initiatives. After public comment, Vice Chair Grove moved to forward the nomination to the full Senate; the committee voted 5-0 to advance the nomination.

What27s next: The committee advanced Sadwith27s nomination to the full Senate for confirmation.