What's changed for Sacramento social services 15 months after Trump's Big Beautiful Bill?

This story is part of "The Poverty Line," a series examining how everyday people are work ing to find housing, buy food or get healthcare amid rising affordability concerns.

In July 2025, President Donald Trump signed into law House Resolution 1, which he nicknamed the Big Beautiful Bill. The legislation ushered in sweeping cuts to safety net programs across the nation, predominately affecting healthcare and Supplemental Nutrition Assistance Programs.

Now, over a year later, these cuts have been felt across both rural and urban areas, and Sacramento has not been immune. From new work requirements for CalFresh benefits to eligibility changes with Medi-Cal and Covered California, here's a deeper look at the changes:

In California, H.R. 1 is having major affects on the following programs and organizations:

Medi-Cal, California's version of federal Medicaid, which provides low-cost medical coverage to people who qualify. Qualification is based on income level, and most adults 19 to 64 qualify if their annual income is at or below 138% of the federal poverty level.

Covered California, California's official health insurance marketplace where people can find, compare, and buy health coverage under the Affordable Care Act.

CalFresh, the state agency charged with delivering federal Supplemental Nutrition Assistance Program (SNAP) benefits to eligible Californians. Eligibility is based on income, and most households must have a total monthly income before taxes that is at or below 200% of the federal poverty level.

Nonprofit food banks, which are serving increasing numbers of people as food-assistance benefits gradually decrease.

H.R. 1 could cause over one million people to lose healthcare access through Medi-Cal, according to an October 2025 report from the California Legislative Analyst's Office.

In response to questions from The Sacramento Bee, Kenneth Casparis, a public information officer for Sacramento County, responded recently that, despite the anticipated H.R. 1 changes, "Individuals lose coverage for a variety of reasons every month. It is unknown at this time how many individuals will lose eligibility as the Department is awaiting final guidance from the state and federal government."

Despite these uncertainties, there are some data points. Executive Director of Covered California, Jessica Altman, said that in Sacramento County there has been a 3.7% enrollment drop from March 2025 to now - approximately 2,400 people.

She said that this decline is due to Congress' failure to extend so-called healthcare Premium Tax Credits. This issue over tax credits was a main demand from the Democratic Party during the October 2025 government shutdown, the longest one in the nation's history.

"Congress could have extended the enhanced tax credits as part of H.R. 1, so declining to do so in itself was an action that did decrease affordability and increase the monthly cost of Covered California coverage for many people," Altman said.

She said that state of California leaders provided funding to fill some of the gap to mitigate the impact of the rising costs of health insurance premiums, but wasn't able to fill the entire hole left by the federal government.

Another H.R. 1-related change set to take effect in January 2027 is that various immigrant groups will begin to see restrictions to their healthcare eligibility.

Only U.S. Citizens and Nationals, Lawful Permanent Residents or green card holders, Cuban and Haitian entrants and citizens from the Freely Associated States (citizens of the Marshall Islands, Micronesia, and Palau) will be eligible for federally financed healthcare.

In Sacramento County alone, Altman said this provision is set to potentially impact 7,500 people now getting health coverage through Covered California, and Casparis said this could impact 25,000 people getting coverage through Medi-Cal.

Additionally, new work requirements for people age 19 through 64 mandate they meet work, volunteer, school, or training requirements to keep Medi-Cal coverage.

The requirements are to either work a job making $580 a month, do seasonal work averaging $580 per month over the past six months, do job training or community service for at least 80 hours a month, or go to school part-time.

These requirements must be met in addition to more frequent eligibility checks changing from annual to six-month renewals, which Casparis said, "will require members to verify eligibility twice a year rather than annually, which could create additional administrative responsibilities for members and counties and increase the risk of coverage loss if deadlines are missed."

In the months following the passage of H.R. 1, the longest government shutdown in the nation's history took place beginning Oct. 1, 2025. Kevin Buffalino, director of communications for Sacramento County Food Bank and Family Services said that month was the busiest month ever in the food bank's history.

April 2026 was the second-busiest month in the organization's history, as it was also the same month many legal immigrants lost access to SNAP benefits administered by CalFresh. This loss of access impacted 30,000 Sacramento-area residents, according to Buffalino.

June 2026 marked the busiest June in history for the food bank, with SNAP eligibility changes for a group called "able-bodied adults without dependents" taking effect. These are people who are between 18 and 64 years old, are mentally and physically able to work and do not have dependents under the age of 14. These eligibility changes are affecting an estimated 50,000 Sacramento region residents.

"If you follow the trail, three of our largest months ever have all been tied to these impacts in the SNAP program," Buffalino said.

The Sacramento County Food Bank serves 329,000 people a month on average, and has seen a 4% increase in people served year over year since the pandemic. "We're hitting hunger levels that we've never seen before," Buffalino said.

Buffalino said the effects of the federal cuts are being felt on a "rolling basis," meaning the food bank will continue to see the impacts as time goes on.

H.R. 1 has paved the way for $187 billion to be cut from federal funding of SNAP programs by 2034, which is a 20 percent decrease, the most in history, according to the Congressional Budget Office (CBO).

That leaves organizations like the food bank to fill the gap.

"For every one meal we provide SNAP, provides nine," Buffalino said. "If those folks are losing that much food they're going to need to find it somewhere else. We weren't designed to replace SNAP, but supplement it. This has been the biggest change leading people to come to the food bank."

Just as healthcare benefits are being affected by new federal work rules, food assistance benefits are, too.

In May, The Bee reported on new work requirements that went into effect on June 1. The new rules, called "work registration," state that residents subject to the rules must take a job if offered one and not voluntarily quit a job or reduce work hours below 30 hours per week "without good reason" to be eligible for SNAP benefits.

If the new work requirements are not met, and a person does not qualify for an exemption, the first possible dates for discontinuance of their SNAP benefits will be in October. About 270,000 Sacramento County residents now get CalFresh benefits; it isn't yet known how many might lose them.

In a July 9 webinar, California Department of Social Services (CDSS) Director Jennifer Troia said that 509,000 people across the state are expected to lose some or all of their CalFresh benefits as a result of this rule.

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