Santa Clara officials tell state HR 1 will hollow out Medi‑Cal and public hospitals, urge immediate backfill

Chair Betty Young called a special meeting to press state partners for help after federal changes known in the meeting as HR 1, which county officials said will sharply reduce Medi‑Cal and food‑assistance funding and threaten the local safety net. "We need to work together in unison and with focus to ensure the most vulnerable...aren't left to fend for themselves," Young said in opening remarks.

County Executive James Williams told the committee the county’s analysis projects more than $1,000,000,000 in ongoing annual reductions tied to the federal changes and described immediate local actions: an aggressive hiring freeze and $200,000,000 in midyear budget solutions adopted to balance the current fiscal year. Williams said the county’s top concerns are support for public hospitals, preserving Medi‑Cal and CalFresh enrollment, and care for the uninsured.

Williams outlined a package of county requests for the state: targeted investments to make public‑hospital funding parity with private providers, funding for eligibility systems and staff to maintain enrollment, and resources to manage an expected surge in uninsured residents. "For every person we can keep on coverage, the federal government covers 90% of the cost," Williams said, urging the state to invest where it can leverage federal matching funds.

Community health leaders backed the county’s requests. Dolores Alvarado of Community Health Partnership said community clinics face catastrophic revenue losses if reimbursement systems and 330 grants are reduced and urged preservation of automated eligibility systems used to enroll and renew Medi‑Cal. Brian Neider of AbilityPath described how people with developmental disabilities could lose supports if eligibility processes fail and urged investments that protect those clients.

Speakers from behavioral‑health agencies, philanthropy and labor warned that state proposals to shift costs (including IHSS or optionalizing mobile crisis services under Medi‑Cal) would worsen outcomes and shift burdens to counties. "Making mobile crisis an optional benefit and shifting those costs to counties will push crisis response back onto law enforcement," Elise Cough Ginsburg of the Behavioral Health Community Association said.

The committee adopted the meeting calendar before presentations; Chair Young said the meeting’s goals were to produce a shared understanding of priorities and clear steps for coordinating county and state advocacy. The meeting concluded with a public comment period in which dozens of clinic leaders, nonprofit executives, workers and residents urged the delegation to prioritize hospital funding, eligibility automation and workforce supports.

The committee did not take new formal legislative action at this meeting beyond adopting the agenda; officials said they will press the county’s HR 1 budget requests through budget letters and direct advocacy with state budget leaders. The committee adjourned and scheduled its next FGOC meeting for April 17, 2026.