Marin girds for funding hit from Trump's 'Big Beautiful Bill'

Sep. 10—Marin County is scrambling to adapt to decreased federal funding for Medi-Cal and food assistance programs as a result of H.R. 1, also known as President Donald Trump's One Big Beautiful Bill Act.

At their meeting on Tuesday, county supervisors received a briefing on the local repercussions of the legislation, which became law in July.

The law will prevent California from continuing to use a strategy it has been employing to boost federal matching funds for Medi-Cal by $7 billion to $8 billion per year. The state has been taxing managed care plans at a much higher rate for Medi-Cal enrollees than for commercial plan enrollees.

"The state collects the tax from the providers, uses it to draw down more federal funding and then pays the providers back," Talia Smith, the county's director of legislative and intergovernmental affairs, told supervisors. "It's really just a way to draw down significantly more federal funding."

H.R. 1 also reduces the share of the cost that the federal government will pay to provide emergency care for undocumented immigrants from 90% to 50%.

Over the past decade, California has expanded full-scope Medi-Cal coverage to include all income-eligible residents regardless of immigration status. Ahmed Ismail, chief fiscal officer for the county's Department of Health and Human Services, estimated that 11,000 of Marin's 54,000 Medi-Cal enrollees have "unsatisfactory immigration status." Unsatisfactory status is a state term that applies to anyone who lacks one of the recognized immigration statuses that qualify for federally funded full coverage.

In addition, federal reimbursement for the state's CalFresh program, formerly known as food stamps and federally known as the Supplemental Nutrition Assistance Program, will be cut and states will begin paying 75% of administrative costs, up from 50%. More than 15,000 Marin residents receive aid through CalFresh.

H.R. 1 implements new requirements for some people covered by Medi-Cal to engage in employment, education, a work program or community service to maintain their eligibility, and it stiffens similar requirements for CalFresh recipients.

Smith said there is uncertainty regarding how these requirements and other aspects of the law will be implemented. In addition to waiting for federal guidance, Smith said local government officials are "also waiting for guidance from the state on how and if this bill will change some of the current cost sharing agreements between counties and the federal government." She said the state Legislature conducted its first hearing on H.R. 1 on Aug. 20.

"A theme that the legislators repeated," Smith said, "is that it is going to be impossible for the state to backfill all of the federal cuts across these programs."

She said it has been estimated that the cuts to Medi-Cal alone could cost California $30 billion a year. The state receives $98 billion in federal revenue from Medi-Cal revenue annually.

The Congressional Budget Office has estimated that H.R. 1 will raise the national deficit by $3.4 trillion over the next decade largely because of the bill's permanent extension of the 2017 Trump tax cuts and an increase in a federal tax deduction that allows eligible taxpayers to deduct certain state and local taxes from their gross income.

As part of the state budget for the 2025-2026 fiscal year, lawmakers peremptorily froze Medi-Cal expansion enrollment for immigrants with unsatisfactory status.

Ismail said the cuts to Medi-Cal and CalFresh will have a domino effect.

"At the community level, more residents will lose coverage, skip preventative care and delay treatment," Ismail said. "This will drive more emergency room visits and increased uncompensated care. Hospitals, clinics and providers will face reduced funding, service cutbacks and longer wait times."

An increase in Marin residents who are ineligible for Medi-Cal will likely increase the number of applicants for the County Medical Services Program, a county-funded offering that provides temporary health coverage for eligible residents.

Smith said that in addition to entitlement programs, H.R. 1 made changes in tax policy, energy policy and climate initiatives. The legislation phases out federal tax credits for rooftop solar, home batteries and heat pumps by 2028. It also eliminates a $7,500 federal electric vehicle credit.

Smith said H.R. 1 significantly increases appropriations for U.S. Immigration and Customs Enforcement and the Department of Homeland Security. On the plus side, she said, the bill made permanent an increase in the number of low-income housing tax credits, which could fund an additional 10,000 to 20,000 affordable residences in California.

Rollie Katz, executive director of the Marin Association of Public Employees, was unimpressed. Speaking during public open time, Katz said, "This so-called big beautiful bill is more than a big, ugly bill. It's a monstrosity. It's obscene."

Mark Shotwell, the chief executive officer of Ritter Center, said the cuts would have a "profoundly negative impact" on his nonprofit's ability to serve its 2,500 indigent clients.

Representing Marin County's four federally qualified health centers, Tracy Mendez, the chief executive officer of Aliados Health, estimated that 6,000 of its patients will either lose their Medi-Cal coverage or end up with much less comprehensive coverage by 2027. Aliados Health is a regional association of 17 community health centers with sites in Marin, Napa, Sonoma, Contra Costa, Solano and Yolo counties.

Crystal Lewis, a patient and board member at Marin Community Clinics, said, "It is vital that we fund and provide unique ways to support our federally qualified health care centers."

Lewis said that in 2019 she was homeless and living in her car.

"I had no insurance and my high blood pressure was out of control," Lewis said. "If it wasn't for Marin Community Clinics, I would be dead."

Originally Published: September 9, 2025 at 5:56 PM PDT

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