Orange County’s neediest families will face new hurdles in the coming months and years to keep their public health insurance and cover doctor visits as officials brace for drastic eligibility changes and funding cuts to Medi-Cal.
The changes are gradually being implemented amid an ongoing membership decline at CalOptima – OC’s managed health plan for the poor that administers Medi-Cal – in the last couple of years.
Now, CalOptima and OC Social Services Agency officials expect President Donald Trump’s “Big Beautiful Bill” or H.R.1, signed into law last year, which greenlit a trillion dollars worth of cuts to Medicaid over about a decade’s time, to add to the decline.
The law also means eligibility changes for recipients of Medi-Cal – California’s Medicaid program – including an already in effect full scope enrollment freeze for undocumented residents as well as expected new work requirements and more frequent renewal applications.
[Read: CalOptima Braces For Health Insurance Eligibility Changes For OC’s Neediest Families]
Orange County Supervisor and Chair of CalOptima’s Board of Directors Vicente Sarmiento said the changes will only add to the financial hardships many OC residents already face and strain hospitals after officials decreased the number of people without health insurance.
“My biggest fear is that we’re going to just have higher costs. The costs are going to shift to hospitals that taxpayers are going to have to pay for. There’s going to be delayed care for everybody because now we’re going to have hospitals that are saturated with people receiving preventive care,” he said in an interview.
“This just becomes a spiraling problem, making people’s lives much, much more difficult.”
CalOptima Chief Operating Officer Yunkyung Kim said while enrollment restrictions to public health insurance isn’t anything new, the changes are coming one after the other at a time when the state has its own budget constraints that makes it harder to fill in the gaps.
“It’s a double whammy in a way because again we’re getting it from a federal policy, state budget, and they’re all happening right around the same time,” Kim said in an interview last week.
“We’ve had times of big enrollment increases, we’ve had times of enrollment decreases. I don’t know that I’ve seen an enrollment decrease of this volume all at once. At least not in my time working in the Medi-Cal program.”
Trump’s “Big Beautiful Bill” isn’t only cutting and changing the public health insurance program, it is also impacting the CalFresh Food Stamp program as hunger continues to grow in Orange County.
[Read: Orange County’s Food Insecurity Continues Growing as Food Stamp Cuts Loom]
“This is a major change in which the stated goal of H.R.1 was to reduce individuals on public assistance,” said An Tran, Director of the OC Social Services Agency, in an interview last week.
Tran and Kim said residents who rely on both benefits may lose two vital lifelines, driving them to food pantries and community health clinics.
“The overall change to both programs are worrisome for me because these are safety net programs and many times many of our families that are on these programs are already struggling to get by, with the high costs of living right now, especially in Orange County,” Tran said.
“Individuals who aren’t able to get their basic needs met are going to have to find other sources in order for them to take care of their families. That is going to put a further strain on community partners, on churches, on food banks.”
Meanwhile, CalOptima has been seeing an enrollment decline since the tail end of 2023 – going from nearly a million members at its peak to 760,000 members on Medi-Cal in July, according to both Tran and Kim.
They say there was about a 100,000 member decline in the past year and membership was dwindling even before H.R.1.
Sarmiento said officials are projecting to lose 250,000 members by July – a 29% decline.
He said the changes to Medi-Cal were aimed at pushing more people off the public benefit program including seniors and people with language barriers.
“We’re dealing with a demographic that already has difficulty complying with the existing criteria for Medi-Cal,” he said.
“These additional requirements quite frankly, in my opinion, were intended to bump off a lot of really vulnerable people who have challenges with mobility.”
OC Supervisor Janet Nguyen, who sits on the CalOptima board, did not respond to a request for comment through her spokeswoman.
Changes to Medi-Cal
A host of changes to Medi-Cal will continue to roll out in 2027 and 2028 under H.R.1.
At the start of this year, a full-scope enrollment freeze for Medi-Cal for certain undocumented residents was implemented barring some adults from signing up for the insurance program because of their immigration status.
CalOptima leaders say undocumented resident enrollment has dropped from 150,000 when they first informed people of the changes to 120,000 today – but can’t speak to specifically as to why the decrease occurred.
Starting next January, some undocumented residents in the county won’t get their Medi-Cal through a managed plan with CalOptima that connects them to a doctor but rather one run by the state through a fee for service type program where the patient has to find their own doctor.
Kim said about 120,000 undocumented residents will be impacted by the transition to the fee for service system – a change she said would be hard to work through and ensure residents won’t face interruptions in their health care.
“In that population are also going to be children with very very severe and special needs who have many specialists that they are seeing right now. Those are the patients that I want to make sure we help them plan for this,” she said.
Come next July, some undocumented immigrants will also have to pay a monthly fee to keep their insurance.
To see immigration status changes to Medi-Cal eligibility, click here.
The changes are not just impacting immigrants.
At the start of next year, some adults between the ages of 19-64 will have to work, volunteer or go to school to be able to keep their Medi-Cal health insurance and they will also be checked every six months to see if they are still eligible for the insurance.
Kim said these changes will impact about 225,000 people in OC who will have to show they meet income and work requirements every six months.
“Six months comes around pretty quickly,” she said.
Kim added they want to make sure people who meet the income and work requirements don’t lose their healthcare just because they failed to get their administrative paperwork together or keep their information up to date.
By October 2028, some adults will also have to pay a copay for certain healthcare services.
To view a full breakdown of the changes, click here.
Tran said the work requirements won’t hit residents all at once even as the changes go into effect, but will impact people when they go to renew their health insurance.
“What we do know is that when you add additional barriers for individuals to receive care, we do anticipate that there will be challenges for individuals to comply,” he said.
“Since this has not been done ever in the history of Medi-Cal, we don’t know what that impact will be, but we do anticipate that there will continue to be reductions in overall individuals receiving Medi-Cal in Orange County.”
Impacts From Cuts & Changes to Medi-Cal
Kim said that those who end up losing their coverage and can’t find affordable alternatives will turn to community clinics who treat people regardless of their ability to pay for healthcare.
At the same time, Kim said some will turn to local emergency rooms – which she said wasn’t a good option for preventative care.
“What we see oftentimes is that individuals who don’t have health insurance, they’ll wait, and then when it becomes something more serious then they go to the emergency room. You’ve been to the ER. I’ve been to the ER. It’s not a great place to get healthcare. It’s also a very expensive place to get healthcare,” she said.
Kim adds both the clinics and hospitals will feel the burden of the changes to Medi-Cal and the cuts to the public health insurance program will mean less money passed down to hospitals
“It’s less money for local hospitals to take care of Medicaid patients and that’s going to be felt by the hospitals in our system, pretty acutely.
“That’s the one that I think probably has the biggest kind of long term impact on healthcare for the entire community is what kind of pressure this puts on our hospitals.”
Sarmiento said the changes will be felt by both the taxpayers and the hospitals – making it hard for low income families to keep their health coverage.
“The consequences of these changes from H.R.1 are going to be higher emergency costs for everybody, greater financial hardship, and more pressure on hospitals and taxpayers,” he said.
“People are going to be getting their care at emergency rooms and hospitals, and that’s not preventive, helpful, and ultimately will cost the taxpayer a lot more money on the back end when they’re having to care for people in these really expensive settings.”
Sarmiento also said the county will be left to address the loss of health care coverage in the region amid federal funding cuts.
“The estimated cost to the county to absorb these people who are losing their healthcare coverage is close to $400 million. Somebody’s got to cover the costs. It’s not like these people stop getting sick once they are disenrolled,” he said.
“This nearly trillion dollars that’s been cut from federal health care and food assistance programs over the next 10 years – these are dollars that we desperately need.”
Earlier this year, CalOptima’s board gave nearly $430 million dollars from their reserves to pay hospitals and specialist doctors more money to treat uninsured patients as they brace and feel the impacts of H.R.1.
In response to the cuts and changes, CalOptima and Social Service officials say they’re focusing on educating people about the changes to help people retain their health insurance.
Kim encouraged recipients who might be impacted by the upcoming changes to visit their doctors now and to keep their information up to date with the Social Services Agency.
“Don’t wait. Don’t think that I will do this later,” she said.
“Get your healthcare now.”
Hosam Elattar is a Voice of OC reporter. Contact him at helattar@voiceofoc.org.
