Contra Costa County, California, is a community of balance. We have waterfront cities and rural communities, heavy industry and open space, and innovation and agriculture.

But what defines us most is our role as the community’s safety net—where policy becomes practice and essential services meet real lives. In recent decades, Contra Costa County has had the ability to deliver services beyond what is mandated. County government is integral to providing healthcare systems and social services within their respective communities.

Our county government is at the center of the federal, state, and local partnerships that deliver healthcare, food assistance, safety-net services, and other important services to nearly 1.2 million residents in the Bay Area.

H.R. 1 at the federal level (also known as the “One Big Beautiful Bill Act” enacted in July 2025) and California’s fiscal year (FY) 2025–2026 state budget both represent a significant shift in that partnership. Together, they push more responsibility and cost onto counties, reduce federal funding, tighten eligibility for safety-net programs, and accelerate impacts to our communities. For counties like ours, the implications are operational, fiscal, and deeply human.

A Structural Shift, Not a Short-Term Adjustment

This is not a routine budget challenge. It is a structural realignment that will have long-lasting negative impacts on parts of the community served.

H.R. 1 reduces federal support for Medi-Cal (Medicaid) and CalFresh (SNAP). It reinstates work requirements, narrows eligibility for certain populations, and cuts federal reimbursement for administration. Reduced federal participation combined with greater local responsibility applies more pressure on county services funded by the county general fund.

Out of a $7 billion budget for FY 2025–2026, general purpose revenues total $822 million, which is primarily funded by property taxes and used to meet required match requirements for federal- and state-funded programs, along with meeting public safety needs in the community.

In Contra Costa County, we locally administer CalFresh and Medi-Cal eligibility and operate the Contra Costa Health Plan, serving approximately 270,000 members—265,000 of whom are Medi-Cal enrollees. We operate a public hospital and nine community clinics.

The estimated fiscal impacts of state and federal policy changes and funding reductions to Contra Costa Regional Medical Center are substantial. This includes cumulative impacts of more than $500 million in FY 2026–2031 and cumulative operating deficits of more than $1 billion during that same timeframe when these funding reductions are combined with a conservative annual 3% expense growth factor. We also anticipate additional costs for uncompensated care to disenrolled residents.

These losses occur while demand rises and operating costs continue to increase.

The Fiscal Cliff Facing Counties

Beginning October 1, 2026, federal administrative funding for CalFresh drops from 50% to 25%. At the same time, work requirements are reinstated for able-bodied adults without dependents. Administrative costs to the county are projected to increase as reimbursement declines.

H.R. 1 has created new eligibility costs for Medi-Cal and CalFresh that are currently not funded. The unfunded mandates include assessing and monitoring work requirements and exemptions for both programs and adding a second annual renewal for Medi-Cal. Medi-Cal eligibility changes begin in 2026 and expand in 2027, including expanded work requirements and elimination of eligibility for certain non-citizen populations. By 2029, as many as 93,000 Contra Costans could lose health coverage.

For CalFresh, approximately 110,000 residents rely on the program each month. An estimated 11–16% of cases may lose eligibility, increasing food insecurity. Federal policy will also shift a portion of food benefit costs to states.

These changes do not happen all at once, but they begin soon and compound quickly. Counties are required to administer these programs regardless of federal participation levels. When reimbursement drops abruptly, the fiscal gap must be absorbed locally through service reductions, staffing reductions, hiring freezes, or deferred investments.

County reserves alone will not solve these ongoing, structural challenges. The scale and duration of the impacts require structural planning, advocacy, and operational adjustments.

The Human Consequences

These supports were designed to help encourage economic self-sufficiency. Our social safety net helps bolster the broader economy and build brighter futures for people and families. Most importantly, behind every data point and every dollar lost is a person who depends on these supports.

It’s the senior relying on in-home support to remain independent. It’s the working parent navigating the CalWORKs Temporary Assistance for Needy Families (TANF) program while trying to keep food on the table. It’s the individual in behavioral health crisis seeking care at our public hospital.

New eligibility rules could affect roughly half of Medi-Cal enrollees. As coverage declines, more uninsured residents will seek care at county-operated clinics and emergency departments at the same time that reimbursement is shrinking. We recognize these changes will also impact other health facilities run by other organizations.

The result has a double impact: reduced revenue and increased demand.

Our social workers will manage larger caseloads. Eligibility workers will process more complex and more frequent eligibility reviews. Health systems will absorb greater uncompensated care. These pressures directly affect service access, wait times, and long-term community outcomes.

What This Means for County Government

H.R. 1 signals a lasting recalibration of intergovernmental finance. More residents will need county services as fewer qualify for federal and state healthcare and food programs. Counties must absorb higher administrative workload, reduced reimbursement, and increased pressure on health systems—all while maintaining fiscal stability.

This is why we are planning early and looking within for efficiencies and effectiveness. Waiting would put both services and fiscal stability at risk.

Our focus is protecting essential services while preparing responsibly for what lies ahead. That means strengthening fiscal forecasting, monitoring implementation timelines, advocating with state and federal partners, and communicating clearly and transparently with our board of supervisors and our community.

County government operates closest to the people we serve. We are where federal policy becomes local reality. When the federal-state-local balance shifts, the effects are felt first, and longest, at the county level.

Our responsibility now is to navigate that shift with discipline, transparency, and an unwavering commitment to the residents of Contra Costa County.

MONICA NINO is county administrator and clerk of the board for Contra Costa County, California.