San Diego County to vote on studying healthcare reforms in response to federal cuts

San Diego County supervisors are preparing to launch a review of the county’s last-resort medical program to help local hospitals respond to the increased numbers of uninsured patients and higher costs due to federal cuts to healthcare.

On Tuesday, supervisors will decide whether to direct county staff to study and propose reforms to County Medical Services, according to a board letter.

The proposed changes to be studied include eligibility standards, and whether patient cost-sharing and lien policies create barriers to care — changes that could increase county-paid care delivered through hospitals and clinics.

The measure was proposed by County Board of Supervisors Chair Terra Lawson-Remer and Supervisor Monica Montgomery Steppe. 

“As the Trump Administration slashes Medicaid payments and rolls back coverage for hundreds of thousands of families, seniors, and children, we must urgently redesign the County Medical Services program,” Lawson-Remer said in a statement to inewsource.  

“When people lose coverage, it doesn’t just affect them; it strains our hospitals, crowds our emergency rooms, and delays care even for those with private insurance,” she added. “In partnership with our healthcare providers, we’re acting now to stabilize our local health system before these cuts ripple through every community.”

Why now: The county estimated that over 300,000 residents are at risk of losing benefits due to changes to Medicaid eligibility in President Donald Trump’s signature federal spending law, the “One Big Beautiful Bill Act,” which passed in July.  

KFF, a nonprofit that studies healthcare policy, estimated that nationally the bill would reduce federal Medicaid spending $911 billion over 10 years and cause 10 million to lose coverage by 2034.

The proposal calls on county staff to work with hospitals in shaping the reforms.

H.R. 1 will have “devastating consequences upon healthcare across this country, and including right here in San Diego. It introduces, without a doubt, the most significant reductions to federal healthcare spending in history,”

Sharp HealthCare CEO Chris Howard said. “The county and hospitals are trying to work together to find additional funding to provide supplementary support services for those individuals who will likely lose their Medicaid eligibility.”

A possible tax increase: Howard said his hopes have fallen on a half cent sales tax a coalition of labor unions and nonprofits are working to get on the ballot in November that would raise $360 million for the county budget to address the Tijuana River crisis, food insecurity and healthcare among other causes. 

Seventeen percent of that funding is earmarked for County Medical Services and could be used to compensate providers like Sharp who would otherwise absorb the costs of caring for uninsured patients themselves. 

“The reality is there are not other great options,” Howard said. “If revenue initiatives like this one are unable to pass, then that burden will fall upon hospitals and to some degree, the county to either provide or not provide those services.”

More cuts, higher expenses: H.R.1 also restricted Medi-Cal financing tools California uses to draw federal matching dollars, which Howard said cost Sharp $50 million immediately when the bill was passed in July with more cuts to kick in in future years. The cuts came at a tough time for area hospitals — both Sharp and UC San Diego Health laid off hundreds of staff over the summer and cut executive pay amid warnings that federal cuts threatened hospitals’ financial solvency.

Healthcare costs are also being pushed up by the expiration of Affordable Care Act subsidies at the end of 2025. More than 140,000 San Diegans and 1.6 million Californians received the subsidies and will now have to pay higher premiums. 

And starting in October of 2026, the county estimated that 75,000 noncitizens in San Diego County will lose access to Medi-Cal. The board letter asks staff to revisit eligibility rules — which currently require U.S. citizenship or ‘eligible alien’ status, among other criteria — and consider potential changes. 

While the county currently describes County Medical Services as “not health insurance,” the letter suggests substantial changes could be on the way. 

“The impact will not only be felt by those individuals who lose their coverage, but it’ll be felt by hospitals that will no longer have the funding to do a variety of other things. And at the end of the day, that means that hospitals will do less and have to make critical decisions about what they’re able to do in the provision of healthcare services. And that will have a significant impact on San Diego County,” Howard said.