San Luis Obispo to explore joining County Medical Services Program as HR1 could swell county‑funded indigent care costs
June 02, 2026 | San Luis Obispo County, California
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Public Health presented options on June 2 for meeting the county’s obligations for medically indigent adults under Welfare & Institutions Code section 17000 and recommended exploring membership in the County Medical Services Program (CMSP) as HR1 changes to Medi‑Cal eligibility take effect in 2027.
Michelle Shoresman, division manager for health‑care access, summarized how HR1 will change Medi‑Cal: more frequent eligibility verifications, new work requirements for some enrollees and a shortened retroactive coverage period (from three months to one). Staff said those changes could increase demand for the county’s locally run Medically Indigent Services Program (MISP).
Citing historical service levels, Public Health offered a very rough, high‑uncertainty estimate that county costs to meet renewed MISP demand could range from about $2.75 million to $13.7 million annually depending on how many residents lose Medi‑Cal coverage and inflation assumptions. Shoresman emphasized the numbers are preliminary and that statewide modeling and county‑to‑county coordination are ongoing through the County Health Executives Association of California (CHEAC).
To reduce the county’s exposure and to evaluate pooled‑risk options, staff recommended submitting a letter of interest to CMSP’s governing board. The letter would allow CMSP staff to work with San Luis Obispo County on draft cost estimates, fees and potential timelines; any participation agreement would return to the Board for approval and would not be binding at the letter stage. The Board voted to authorize staff to submit the letter of interest and continue evaluating options, including possible partnerships with counties such as Santa Barbara and groups organized by CHEAC.
What’s next: staff will continue CHEAC coordination, pursue cost‑benefit analysis and return to the board with options and a recommended path forward once cost estimates and model comparisons are available.
Michelle Shoresman, division manager for health‑care access, summarized how HR1 will change Medi‑Cal: more frequent eligibility verifications, new work requirements for some enrollees and a shortened retroactive coverage period (from three months to one). Staff said those changes could increase demand for the county’s locally run Medically Indigent Services Program (MISP).
Citing historical service levels, Public Health offered a very rough, high‑uncertainty estimate that county costs to meet renewed MISP demand could range from about $2.75 million to $13.7 million annually depending on how many residents lose Medi‑Cal coverage and inflation assumptions. Shoresman emphasized the numbers are preliminary and that statewide modeling and county‑to‑county coordination are ongoing through the County Health Executives Association of California (CHEAC).
To reduce the county’s exposure and to evaluate pooled‑risk options, staff recommended submitting a letter of interest to CMSP’s governing board. The letter would allow CMSP staff to work with San Luis Obispo County on draft cost estimates, fees and potential timelines; any participation agreement would return to the Board for approval and would not be binding at the letter stage. The Board voted to authorize staff to submit the letter of interest and continue evaluating options, including possible partnerships with counties such as Santa Barbara and groups organized by CHEAC.
What’s next: staff will continue CHEAC coordination, pursue cost‑benefit analysis and return to the board with options and a recommended path forward once cost estimates and model comparisons are available.
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