Medicaid cuts could threaten rural health care in Mendocino County

MENDOCINO CO., 7/23/25 — The impact of President Donald Trump's "One Big Beautiful Bill," which is expected to strip millions of Americans of their health insurance, could be particularly stark in rural areas like Mendocino County where residents have minimal access to health care.

The legislation, which Trump signed into law at the beginning of July, introduces major cuts to Medicaid, known as Medi-Cal in California. It is a federal health insurance program for low-income people, including children and families, pregnant women, and people with disabilities.

In California, Gov. Gavin Newsom estimates that cuts from the One Big Beautiful Bill could result in 3.4 million Californians losing health coverage.

Mendocino County has 91,601 residents, according to the latest numbers from the U.S. Census Bureau. As of May, 42,134 or nearly half of those residents were enrolled in Medi-Cal, according to the California Department of Health Care Services.

According to a statement released by the Adventist Health Ukiah Valley hospital, a high percentage of patients there use Medicaid, so the new law could threaten the stability of local hospitals and clinics that rely on financial reimbursement from Medicaid to operate.

"As a health care system committed to serving our communities with compassionate care, Adventist Health is deeply disappointed in the outcomes of the Reconciliation Bill vote because of the catastrophic impact it will have on access to care for all," the statement reads. "More than 70% of our patients who enter our hospitals rely on Medicaid and Medicare for their care. Additionally, this legislation threatens to widen disparities and undermine the financial stability of hospitals and clinics, which are the lifeline and economic engine of local communities."

The legislation's cuts could lead to permanent closures of hospitals and clinics in rural parts of California and throughout the country, according to a June 12 letter sent by Senate Democrats to Trump and Republican leaders in Congress. The letter said the legislation would result in the biggest cuts to health care in American history and listed 338 rural hospitals across the U.S. at risk of closing due to the legislation passed by Trump.

One of those hospitals is Adventist Health Ukiah Valley, the only hospital in all of Mendocino County with a licensed labor and delivery unit. The only other operational hospitals in the county are in Willits, approximately a 30-minute drive from Ukiah, and Fort Bragg, which is around an hour and 30-minute drive from Ukiah. The hospitals in Willits and Fort Bragg do not have labor and delivery centers.

Mendocino County is the 15th-largest county in the state, covering about 3,509 square miles. The closure of a hospital in the county could profoundly affect residents' access to health care. If a hospital in Ukiah — the county's largest city — were to close, it could bring longer emergency response times, overcrowding in nearby hospitals and medical centers, and worsen existing health conditions of residents.

Julie Beardsley, a former epidemiologist with the Mendocino County Public Health Department, explained in an interview that the potential closure of the Ukiah hospital could bring serious consequences.

She said people would have to travel long distances for medical care, which could be detrimental during an emergency.

"We're bigger than Rhode Island … if it were to close, where are people going to go for health care? They'd have to go to Santa Rosa," Beardsley said about a potential closure of Adventist Health Ukiah Valley. "What if there's a car accident and somebody's bleeding out? The hospital just cannot close. It's a huge public safety issue."

Beardsley explained a few ways that the new law would cut Medicaid and make it more difficult for people to register for health insurance. One of the rules outlined in the legislation increases the work requirements for Medicaid eligibility.

For the first time since the program's creation, applicants must complete at least 80 hours of work per month, which could include volunteering, studying or community service, to be eligible.

In addition, the law increases how often Medicaid recipients must report their annual salary, requiring them to do so twice a year instead of once, which was the previous rule.

"When you think about it, people forget. They might not understand the requirements, or maybe they don't have a computer," Beardsley said. "Most people have phones, but some don't. There's an access problem."

Beardsley also said the new eligibility rules could increase the number of people who need immediate treatment while being uninsured, potentially leading to debt for those who visit the hospital during an emergency.

"If people lose coverage because they forget to refile or don't understand the new requirements, they'll end up in the ER," she added. "Just walking into the ER is $2,000. Then they'll end up in massive medical debt."

In addition to increasing both the work and reporting requirements for eligibility, the legislation will limit provider tax rates, which means that it will pause or decrease the amount of money that states can contribute to their Medicaid funding.

The federal government determines how much funding each state receives based on its wealth compared to the national average. California's rate is 50%, meaning the federal government matches each dollar the state raises for its Medi-Cal program.

States can raise money for health insurance in different ways, including taxing hospitals and medical providers. In California, those taxes help redistribute funding to medical centers in low-income and underserved parts of the state. These taxes are called "provider taxes."

The money is then added to California's 50% share and brings in more federal funding. For example, if California were to raise $1 million in provider taxes, it would then receive another $1 million from the federal government in matching funds. But the new law will scale back provider taxes, reducing the amount of money states are allowed to raise to request matching funds from the federal government.

In addition to the One Big Beautiful Bill, there are other new policies being implemented that will impact immigrant communities and their access to health care.

Low-income Californians, including immigrants without permanent legal status, are eligible for Medi-Cal under California's Health4All initiative, which was implemented in January 2024.

These immigrant communities are not eligible for other insurance under the Affordable Care Act, which was passed in 2010 and extended Medicaid programs to more low-income people across the nation. Immigrants without legal status rely solely on Medicaid and other social programs to receive health care.

On July 10, the U.S. Department of Health and Human Services sent out a press release stating that the federal government is rescinding the 1998 version of the Personal Responsibility and Work Opportunity Reconciliation Act. This legislation, which was originally introduced during the Clinton Administration in 1996, allowed immigrants without permanent legal status to access public health benefits.

This means that the government is now mandating that hospitals and clinics limit the resources that immigrants without permanent legal status can access, narrowing the health care that those communities need.

The services that will be restricted include mental health care at behavioral health clinics, substance use prevention programs, and Head Start services. Head Start is a federal program overseen by the Administration for Children and Families, a division of the U.S. Department of Health and Human Services, that provides educational and health resources to children and their families.

The press release also said that while this interpretation of the legislation will not cut funding, it will save the federal government money by limiting resources available to immigrant communities.

"While the updated interpretation does not alter funding levels, it ensures that public resources are no longer used to incentivize illegal immigration," the press release states.

On Monday, California Attorney General Rob Bonta sued the Trump administration because of this decision to limit public benefits for immigrants without permanent legal status.

A press release by Bonta states, "Examples like this are countless across the public benefits programs at risk through the Trump Administration's actions. Survivors of domestic violence and at-risk youth may be fearful of seeking services at shelters. Mixed status families may forgo access to public benefit services all together. Requiring citizenship or immigration status verification of any kind fundamentally creates a barrier to access."

James Stewart, CEO and executive director of the Long Valley Health Center in Laytonville, said he is concerned about the HHS letter and the implications for immigrant communities.

"I'm afraid. I've been in public health for 30 years, and I'm afraid. It breaks my heart," Stewart said.

Stewart also spoke about how the One Big Beautiful Bill will put unnecessary strain on rural communities that already have little access to medical resources.

"We have folks that are our patients that are living off the grid," he added. "That's a whole group of Californians that people are ignoring. If we ignore them, that's to our detriment, and it's morally wrong."

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