Sacramento County is warning that approximately 15,000 local residents are expected to lose health coverage as new federal Medicaid work requirements take hold, a shift county officials say could saddle the county with tens of millions of dollars in new costs and push more uninsured patients into already strained emergency rooms.
The county made the warning in a social media post this week, stating that H.R. 1 is expected to create around $17 million in new costs for Sacramento County in the current fiscal year and roughly $58 million in new costs next fiscal year, according to Sacramento County. Counties across California are legally required to serve as health care providers of last resort for low-income, uninsured residents who have no other source of medical coverage, a mandate rooted in California Welfare and Institutions Code Section 17000. That means as Medi-Cal enrollees are dropped from the state and federal rolls, the burden of caring for them does not disappear — it shifts to local governments.
The federal law behind the disenrollment wave, H.R. 1, was enacted in July 2025 and requires Affordable Care Act Medicaid expansion adults ages 19 to 64 to complete 80 hours per month of work, education, or community service to keep their coverage starting January 1, 2027, according to the Center for Health Care Strategies. The law also shortens Medicaid expansion redetermination intervals from twelve months to six months, meaning enrollees must prove their eligibility twice as often. The California Department of Health Care Services estimated in May that 4.8 million Medi-Cal enrollees statewide are subject to the new work requirements, and the department projects roughly 1.1 million Californians will lose coverage by fiscal year 2029–30, per the California Health Care Foundation. State health policy experts note that many enrollees will lose benefits due to complex administrative paperwork rather than actual income ineligibility.
County Asks State for Emergency Bridge Funding
Sacramento County and other California counties are asking the state for $100 million in one-time bridge funding, which the county says it plans to use to provide indigent care to affected communities. Sacramento County has warned that emergency rooms could become overwhelmed and local health systems could come under strain if that funding does not materialize…