MENDOCINO CO., 1/16/26 — During the second session of the Mendocino County Health Summit organized by the county, health care administrators and professionals shared what challenges in funding and patient eligibility they are preparing to face due to the budget cuts of the One Big Beautiful Bill Act, or H.R. 1, which President Donald Trump signed into law on July 4, 2025. The act is expected to reduce federal Medicaid spending by more than $1 trillion over the next 10 years, according to the Congressional Budget Office.
Governor Gavin Newsom released his proposed state budget Jan. 9, which contains more cuts and policy changes to eligibility for reimbursement and funding. Between federal and state cuts — in a county with nearly half of all residents on Medi-Cal — the prospects of non-insured patients, overloaded emergency services and higher costs seem inevitable. It remains to be seen whether the county’s emergency services and clinics are capable of weathering the storm. And the human cost is only beginning to come into focus.
Wednesday afternoon’s summit was held in the Mendocino County Board of Supervisors chambers. The supervisors asked few questions as they listened to the presentations. About a dozen audience members attended, and the presentations were—and are—available on the county’s YouTube channel.
Emergency services could suffer a cascade of challenges
Mendocino County Public Health Administrator Tami Bartolomei said that federal and state payments for Medicare and Medi-Cal do not cover the actual costs of service, leaving a significant reimbursement gap. This can have a large impact on the county because nearly half of county residents are insured by Medi-Cal. Bartolomei said these cuts will also impact the amount local providers are reimbursed for services.
Bartolomei referred to a June 2025 article from the Journal of Emergency Medical Services to explain cost shifting, when higher bills for private insurance subsidize losses from government programs and uninsured payments. She explained that community health systems, including 911 calls, dispatchers, emergency medical technicians, and others could become unsustainable.
“When public reimbursement rates decline or the uninsured rates rise, providers increase charges to commercial insurers that make up the difference,” Bartolomei said. “This cost-shifting dynamic erodes public trust, distorts market signals, and undermines the ability of prehospital care systems to plan and invest based on predictable funding streams. As the rate gets lower, the less they’ll be reimbursed, if at all in some cases.”
Revenue could also decline as patients opt out of carrying health insurance, reducing ambulance revenue by 15 percent or more, a figure determined by the American Ambulance Association.
New policies regarding eligibility have huge effects
As of Jan. 1, new Medi-Cal applications for undocumented adults are limited to emergency Medi-Cal only.
According to Bartolomei, loss of access to primary care is expected to cause a surge in low-acuity 911 calls, meaning there could be a higher number of 911 calls for less serious problems rather than those patients using primary care.
“Without a primary care physician, individuals tend to utilize the 911 system as their primary healthcare entry point for non-urgent or chronic conditions,” Bartolomei said.
Moreover, the reinstatement of the Medi-Cal asset limit and increased verification will create administrative workload for billing departments and likely cause coverage loss for vulnerable populations.
“Providers may see a shift payer mix as patients move from covered to self-pay, which has a historically lower collection rate. More frequent checks increase the risk of those who may experience periods where they are temporarily uninsured,” Bartolomei said.
Jen Banks, an emergency services coordinator for Coastal Valleys EMS Agency, which contracts with Mendocino County, provided a grim forecast of possible solutions for increasing revenue and sustainability. There is no immediate fix, she said, but solutions over time might involve local tax measure proposals and pursuing federal grants.
Mendocino County Deputy Director of Social Services Rachel Eber-Elliott explained the impact of the Medi-Cal eligibility requirement changes. As of November 2025, Mendocino County had 36,628 county-administered Medi-Cal beneficiaries. About 13,000 of those residents, or about 38 percent of the county’s caseload, will be subject to the work requirements mandated in H.R. 1, starting in 2027. And 6,000 beneficiaries will be subject to the reinstated asset limit that went into effect Jan. 1. Eber-Elliott said that the effects of the asset limit eligibility change may not be evident until the first quarterly report this year.
The effect on in-home supportive services could be dramatic
Mendocino County Deputy Director of Adult and Aging Services Jesse Vanvoorhis spoke about impacts to the in-home supportive services, which allows people who need caregiving to stay in their homes with in-home assistance. IHSS is a subprogram of Medi-Cal, so to qualify for IHSS, recipients must also qualify for Medi-Cal, meaning changes to Medi-Cal could affect a recipient’s ability to qualify for in-home care.
The governor’s proposed budget contains a proposal to remove what Vanvoorhis called a failsafe. Currently, when someone loses Medi-Cal eligibility, that person can still receive IHSS care until a social worker examines the case. The governor’s proposed budget would end IHSS eligibility on the same day someone’s Medi-Cal was terminated.
“There are concerns, but of course the state is looking to reduce costs. IHSS is a very costly program, but it’s important. It keeps people in their home,” Vanvoorhis said. “It’s more affordable caring for someone in their own home than having them go in a nursing home.”
Cuts with teeth
One change in H.R. 1 ends eligibility for dental coverage for those with “unsatisfactory” immigration status, which can mean anything from violating the length of a visa or working without a permit. This change, which goes into effect July 1, comes with a cost, according to Mendocino Coast Clinics Executive Director Lucresha Renteria. Those that lose dental coverage will be put on a sliding scale at clinics with federally qualified health center status. Renteria said that for her clinics, that will mean a loss of about $200 per dental appointment.
“I don’t know how many patients that is because we don’t want to track anyone’s immigration status,” Renteria said.
Renteria also broke some bad news during the summit. She stated that the night before, the coastal clinics lost about $400,000. Its substance abuse and mental health services program funds were cancelled without warning and without a way to reinstate those funds.
“As we try to plan and look at these things, we don’t know when we’re going to get a surprise email from this administration,” Renteria said.
The summit wrapped up with county CEO Darcie Antle announcing that she is retiring from her position at the end of June. It’s unclear what impact that will have on concrete actions the county might take to address challenges that clinics, emergency providers and health care professionals will meet as budget cuts and eligibility policy changes take effect.
My doctor wrote me a referral to go to Adventist Outpatient Pavilion for an X-ray of my lungs (two pictures) to check for pneumonia. They asked me to sign the estimated cost, nearly 1,300. When I complained about the cost, they said you have good private insurance, your cost is only 400. I walked out, drove to Santa Rosa Imaging. They said my cash price with NO insurance was $75. And with insurance my share was $50. I was in and out with twenty minutes, their written radiology report was sent to my doctor within four hours. Adventist can charge Emergency prices because of their ER, as if I was airlifted in the middle of the night, they called in a radiology tech and radiologist to save my life. The insurance billing codes are not the same. As long as we do not have ethical, honest medical billing, we will continue to have a healthcare crisis. As long as we have corporations that are predatory and unethical in their billing, the healthcare that people can afford will be inadequate. This billing scheme needs to change in Congress. Who protects the consumer? Adventist told the BOS they would NOT take advantage of us if they were permitted to have a monopoly in our county. Adventist said they were a non profit. I also went to Adventist four years ago for a CT of my knee. Their estimate was $2,900. I went to Santa Rosa Imaging. They charged $500. And my share was $50. Why are doctors only referring patients to Adventist knowing that they are charging Emergency prices? Is it because nearly all doctors offices were also bought up by Adventist? I cannot be the only one who has noticed this scam. They also do this with any labs. I go to Quest in Healdsburg. Adventist’s $600. Test is only $65. At Quest with a $9. Copay. Adventist has sent me multiple letters over the years saying they are not in-network with my insurance and are negotiating NEW prices. With the loss of their funding, I know they are expecting the people with private insurances to make up their loss. I am positive, we with private insurance will ALL be getting letters soon. If you can, shop around and travel South for affordable medical services. I feel for the elderly and disabled who may not have this option. They will expect the working class to make up for what they are losing.
Is any of this new? Truly new? Or more of the same? The dismal state of Healthcare and providers in Mendocino County has been a long festering wound with pus filled dressing. Looking back 20 years, care has been expensive and inadequate. These “non profits” have boilerplate statements posted near the entrances “Care will not be refused due to an inability to pay. ” Yet they do, chase folks with payment contracts, bill thousands for basic care forced to the ED. Situations that are serious overlooked, ignored, excused away have many times cost patient’s lives due to the poor, biased, limited care that is received. Antle is out, big surprise there??? Few years, big salary average she is walking out vested benes, around 5k a month no sweat off her back, she was an Adventist Nepo baby from a decade ago. Her total pension package puts her out of the average Mendocino County’s resident’s actual experience. Banks is in a similar realm at a lower ladder rung.
Interesting a lot of ” could, may, not yet knowns” are thrown out as potential impacts without real time data. The non profit hidden profit dance silently churning for longer than Adventist cares to admit. They have us all by the…
$25 bandaids, $3000 xrays. Perfect!!! Way too much is spent at the top to keep the top at the top meanwhile the bottom foundations are crumbling to dust. When there are no more un insured or poor to lord over where does their profit and power come from then??? They will be feeding upon each other in the end. Lower income folks are forced out of rural areas with this process. It is much more complex than what is eluded to in this article. Spending $ on a summit that was all recirculation of emails and outside cut n pastes got it. Vital need there. Healthcare needs to be free of insurers chokeholds, shifted to cash fees. Example xray straight cost $100, MRI $1800 Ill pay it. $75 office co pay caps at $4500 out of pocket fees. At $300 a check. $600 a month. $7200 a year I get 1 office prevention visit, thousands in co pays to boot, what does my premium cover??? Oh administrators and fees got it!!! So what’s the co pay for? Profit , profit, profit choo chooooooo.
You know it irks me when we start hearing about health care cuts. When you go to the hospital or doctor and they put a bandaid on you they charge an astronomical fee. I don’t know how many people go in after getting a bill or after a procedure and ask for an itemized bill and everyone should. I will say the care in willits has gone way down hill way down. You have nurses on duty that say they can’t do their job. For instance my mother in law could not get up on her own and was in the hospital she needed to use the restroom, her nurse came in and said oh I can’t do this, my mother in law weighs about 130 if we are lucky and she just couldn’t put weight on 1 leg she’s 87. So why was this nurse even there so she could sit and take notes? When we have appointments and are 5 minutes late they won’t let us see the doctor but when we are on time we sit in the lobby for 15 minutes then we sit in a room for 45 minutes or better. Do they get paid oh absolutely. You people need to think about how you waste money on senseless things and less than mediocre service. You blame cuts on Medicare and medical but don’t look at yourselves. Since Adventist Health took over its been terrible. I would rather die than go to one of these hospitals especially in mendocino county. I should have had surgery many years ago but I refuse so I suffer.
Are the medical providers, Adventist Health in particular, admitting that these cuts will hurt their businesses because their business model is based upon making money off of billing for patients who are ineligible for Medi-Cal? And tolerating significant fraud as long as they get their reimbursements?