Up to 93,000 Contra Costa residents could lose their Medi-Cal coverage due to new restrictions imposed by Trump’s One Big Beautiful Bill (OBBB), according to county projections.
Lisa F., a Richmond resident, said that losing her Medi-Cal health insurance would be a “life or death situation.”
Lisa, 58, who didn’t want her full name published for privacy reason, suffers from several chronic physical and mental conditions: polycythemia vera (a blood cancer); Hashimoto’s thyroiditis (an autoimmune condition); degenerative disc disease (a spine condition); and bipolar disorder.
“I am trying to manage my own health for when these [Medi-Cal] cuts come,” she told Richmondside. For Lisa, this means stockpiling medication and trying alternative therapies.
Lisa needs an expensive medication, Fanapt, to control her psychiatric symptoms. If she were to lose her Medi-Cal coverage, she would not be able to afford it. Even with a Good Rx coupon, the medication costs more than $2,300 a month.
“I am at the point where I’m hoarding medication,” she said. Sometimes, she cuts her pills in half to make tablets last longer. She saves her expired medication, preparing for the worst case scenario in which she is not able to get a new prescription.
“I hope my psychiatrist doesn’t read this,” Lisa laughed wryly.
Lisa has heard about Trump’s One Big Beautiful Bill (OBBB) and cuts to healthcare, but she is unclear on what she needs to do to keep her coverage.
Trump bill imposed new health insurance restrictions
OBBB imposes several new restrictions on Medicaid, a joint federal and state-funded program that offers health insurance to low income Americans. California’s Medicaid program is called Medi-Cal.
Federal and local governments alike anticipate that many like Lisa will lose their coverage. Such OBBB restrictions will result in fewer Medi-Cal enrollees. Fewer enrollees means decreased federal reimbursement for care.
Get help enrolling in Medi-Cal
For help enrolling in Medi-Cal, call the Contra Costa County Employment and Human Services office, 866-663-3225, or visit BenefitsCal.com.
As this federal reimbursement is projected to decrease, states and counties are scrambling to balance their healthcare budgets while maintaining services for the most in-need residents, like Lisa.
Predictions about a growing uninsured population and lack of reimbursement have alarmed patients, hospitals, and government officials alike. As Contra Costa County weighs different options to pick up the slack, it is clear that no option is without consequences.
“I’m not going to sugarcoat it. The funding reductions we face are unprecedented,” said Grant Colfax, the director of Contra Costa Health, at a December county Board of Supervisors meeting.
Timeline of Medi-Cal changes
To balance the loss of federal dollars for Medi-Cal, California has implemented new cost-saving measures. Both federal restrictions and state budget cuts are expected to cost Contra Costa County up to $307 million through 2029.
New OBBB restrictions will prevent those with “unsatisfactory immigration status” (UIS) from enrolling in Medi-Cal. This federal change is set to begin Oct.1. However, the state already froze enrollment for those with UIS on Jan 1, 2026, as previously reported by the Richmondside.
Marla Stuart, the county’s director of the Employment and Human Services, said that people with UIS already on Medi-Cal should not see any changes to their benefits in October.
But starting on Jan. 1, 2027, some enrollees will be required to report work. Per recent guidance from the California Department of Health Care Services, this can be satisfied by a minimum monthly income of $580. Many, including parents with children younger than 14, caretakers of disabled people, and medically frail individuals, will be exempt from this requirement.
Many adults on Medi-Cal must also renew their benefits every six months, compared to the previous annual renewal requirement. Pregnant women, women who gave birth in the last year, foster youths, and Native Americans will not be subject to this change, and will be able to renew annually.
On July 1, 2027, new monthly premiums will go into place for those with UIS.
OBBB will affect other health insurance options for undocumented people
“There’s a large pool of people that just will no longer be eligible for Medi-Cal,” due to state and federal changes, said Amit Randhawa, clinic operations manager of RotaCare West Contra Costa (RotaCare WCC).
RotaCare is a Bay Area nonprofit where medical professionals volunteer to provide free primary and urgent care to uninsured patients through nine clinics, including the clinic Randhawa manages in San Pablo. It’s funded by local Rotary clubs, private donations and grants.
Since the beginning of the year, Randhawa has noticed an increase in people requesting appointments and information about Medi-Cal changes.
The demand for free medical care in west county outweighs the availability, Randhawa told Richmondside. Rotacare WCC currently offers 600 appointments per year — nowhere near the number needed to help all of the Contra Costa residents who could lose their health insurance.
Jessica Altman, the executive director of Covered California, said in an email to Richmondside: “[OBBB] also limits which immigrant groups will be eligible for financial help to help pay for their insurance through Affordable Care Act (ACA) marketplaces, like Covered California.”
Without financial assistance, clients with UIS “would have to pay the full cost of coverage, off-exchange or through insurance companies directly,” said Altman.
Randhawa said this higher cost of coverage will be prohibitive.
“We still may be able to help [patients] access other insurance applications. But they have to be able to afford those. And most of our patients have very limited means, and they’re not able to pay for insurance out-of-pocket,” Randhawa said.
Officials consider ways to keep people on Medi-Cal
“Keeping people on [Medi-Cal] needs to be the priority, and there’s really no plausible scenario where that wouldn’t be the most effective strategy,” said Colfax at the December supervisors meeting.
By the end of 2025, Contra Costa county had already planned to add 14 hours of training for 550 eligibility workers to better assist residents applying for Medi-Cal and other benefits. Stuart estimated this training would cost $1.3 million.
Stuart’s department will experience a 36% increase in workload to comply with new OBBB requirements. She said this will cost $27 million.
Gov. Gavin Newsom’s initial budget did not include funds to help counties implement OBBB, but it’s not yet final.
County elected officials have also been discussing expanding the county’s Basic Health Plan.
This plan is not a health insurance plan. It allows low-income Contra Costa residents who are not eligible for Medi-Cal to access limited care at community clinics. As of December 2025, there were only 15 people enrolled, as undocumented Californians previously were able to sign up for Medi-Cal and Covered California, which are better insurance plans. It would cost $12 million to cover 5,000 adults under this plan, Colfax said.
Cost-cutting at the county level is unlikely to make up for the loss of hundreds of millions of federal dollars, Colfax said. Other options to increase revenue should be considered. He pointed to Measure A, a 5/8th cent sales tax increase passed in November 2025 in Santa Clara County to help with certain healthcare costs.
At the state level, legislators are considering several bills to limit unnecessary terminations and shore up state systems. State Assembly member Catherine Stefani (D-19), representing parts of San Francisco and San Mateo, introduced AB 2208 to limit cost-sharing for Medi-Cal members affected by OBBB.
Assembly member Tasha Boerner (D-77), representing parts of San Diego, has introduced AB 2201, which would reduce some of the income and asset documentation required for determining Medi-Cal eligibility. However these bills are a long way from becoming law.
While the county and the state weigh different options, Randhawa is trying to help patients on the ground.
“We’re navigating it, counseling our patients best we can,” said Randhawa, “but, if there are limited options, there are limited options.”
“We can’t conjure things up.”
