Contra Costa County is sounding the alarm: an estimated 1.4 million Californians could lose Medi-Cal coverage under H.R. 1, a federal law that layers new work rules and eligibility checks onto the program. In a post on X today, county officials warned that the change could threaten care for some of the state’s most vulnerable residents and urged Sacramento to put more money on the table to blunt the impact.
What H.R. 1 Would Change
H.R. 1, enacted in 2025, rewrites key Medi-Cal rules for adults who gained coverage through the Affordable Care Act expansion. Many of those adults will now face a new work or community engagement requirement. The law also doubles how often some eligibility redeterminations must happen and tightens rules for noncitizen eligibility.
The rollout stretches across 2026 and 2027 and will force counties to run far more eligibility checks and monitor people’s work status, driving up administrative costs. According to the Legislative Analyst’s Office, the law also broadens the types of eligibility errors that can trigger federal penalties, raising fiscal risks for counties and the state.
How Many People Could Be Affected
The 1.4 million figure the county flagged is not a catch-all for every part of H.R. 1. It refers specifically to projected coverage losses tied to the new work requirement. A presentation to the Assembly laid out a county-by-county breakdown that attributes roughly 1.4 million potential Medi-Cal losses to the work rule alone.
When six-month renewals, lost subsidies and tighter immigrant-eligibility rules are added to the mix, state officials and budget researchers warn the total could rise substantially, potentially affecting as many as 3.4 million people and putting more than $30 billion in federal funding at stake, according to the California Health Care Foundation.
Local Consequences And County Response
Contra Costa officials are using the statewide projections to make the case for more money to keep clinics, community providers and county services solvent as the new rules roll out. County documents previously cited in an earlier Hoodline report projected that nearly 93,000 residents risk losing Medi-Cal in Contra Costa by 2029 under related budget scenarios.
In its latest social media message, Contra Costa County said it supports “more state funding” to keep essential services running as the changes take effect.
1.4 million Californians risk losing Medi-Cal due to H.R. 1, threatening care for our most vulnerable.
— Urban Counties of California (@countiesurban) April 6, 2026
We support more state funding to keep essential services running.
Learn more about it in today’s Budget Subcommittee No.1 Hearing: https://t.co/gt39fXO8LP #HR1
What Residents Should Watch For
Counties and state agencies are already trying to get ahead of the disruption with outreach campaigns, including text messaging and partnerships with community groups, to reach people before renewals and new reporting rules fully kick in. County Social Services Agency pages and state FAQs urge beneficiaries to keep their contact information up to date, respond quickly to any notices and call county social services offices or 2-1-1 for help.
In Sacramento, lawmakers have introduced bills aimed at automating more renewals and reducing coverage losses caused by paperwork problems, a set of proposals summarized by Health Access.
What Happens Next
County leaders and advocates say the coming months will be critical as federal guidance and state implementation rules are finalized and funding decisions are made at the Capitol. Advocates note that when similar work and paperwork requirements have been tried in the past, eligible people have often lost benefits because of administrative errors, a risk highlighted by the California Budget & Policy Center.
Officials on the ground say that additional state funding, paired with more automation to ease the paperwork burden, will be key to avoiding large gaps in care for people who still qualify for Medi-Cal on paper but could be tripped up by the new rules.
