Counties Ask Legislature for $100M One‑Time Bridge as Indigent Care Demand Grows

County leaders representing Santa Barbara, San Diego and Tulare Counties told the committee that their indigent care systems were largely inactive after the Medicaid expansion and will require immediate funding and rapid rebuilds to meet expected demand.

Tanya Heitman, assistant county executive officer for Santa Barbara County, said the county has set aside roughly $5,700,000 this year but that rebuilding the program will require updated state partnership and statutory clarifications. "By 2029, more than 21,000 residents may meet eligibility criteria for the program," Heitman said.

Elizabeth Hernandez of San Diego County said the county estimates roughly 309,000 people will be subject to new work requirements and about 68,000 will be unable to meet them; San Diego has few county‑operated clinics and would rely on community partners to serve increased CMS patients. Jason Bridal, Tulare County administrative officer, urged immediate one‑time support and estimated Tulare would need millions to restore capacity. "We must hire physicians, establish eligibility and treatment authorization processes... and provide nursing support," Bridal said.

Several county representatives and associations asked the Legislature for a $100,000,000 one‑time general fund bridge to begin covering emergent costs and avoid counties diverting general funds from public safety and other services. County officials proposed flexible allocation that recognizes county differences (some counties are in pooled models like CMSP and many are 'article 13' counties with little existing infrastructure).

Why it matters: Counties are the implementers of indigent care under WIC 17000; without bridge funding, officials said they will either be unable to pay for emergent care or will cut other essential services to comply with statutory obligations.