Mendocino County’s healthcare backup to Medi-Cal may cut its eligibility and benefits

FORT BRAGG, CA., 9/18/26 — When Medi-Cal work requirements take effect Jan. 1, the program that’s supposed to catch Mendocino County residents who lose their coverage may narrow its own door on the same day.

The County Medical Services Program covers people who can’t get Medi-Cal in Mendocino and 34 other counties, most of them rural. It’s the coverage of last resort. It wants to cut its income cap from 300% of the federal poverty level to 200%, and its asset limit to $10,000 for a single person and $20,000 for a couple. It would drop coverage for vision, hearing, chiropractic care, outpatient substance use treatment and mild-to-moderate mental health care, program officials told the Mendocino County Board of Supervisors on Tuesday. Undocumented residents would get emergency care only.

The first of two public hearings on the changes is Friday, 9:30 to 11:30 a.m., in Sacramento and on Zoom. The second is Oct. 5. Written comments are due by 4 p.m. the business day before each hearing at info@cmspcounties.org, according to the program’s notice.

The presentation came during the board’s third health summit on H.R. 1, the federal budget law passed last year, held in the Fort Bragg Veterans Memorial Building Tuesday. Kari Brownstein, the program’s executive director, said the cuts are a matter of the program living within its means. The program’s revenue went to the state after the Affordable Care Act moved most of its patients onto Medi-Cal. Now patients are coming back, but the money isn’t, Brownstein said.

If a third of the people expected to lose Medi-Cal over work requirements come back to the program, that’s 32,555 to 41,004 people across the 35 counties it serves at a cost of $247 million to $311 million a year, according to the program’s slides. For Mendocino County, Brownstein put the estimate at 1,000 to 3,500 people. The county had 3,778 people in the program before the Affordable Care Act.

The program has a reserve of about $312 million, enough to get through this fiscal year, Sarah Dukett, a senior policy advocate with the Rural County Representatives of California, told the board. Once it’s gone, the county could again owe a participation fee that has been waived since the Affordable Care Act expansion. Mendocino County’s share is $247,578 a year, according to the program.

The state Legislature’s budget plan included a state-only emergency Medi-Cal category for people losing coverage, and counties asked for $100 million in August. The administration rejected the first in June’s final budget, and the $100 million was left out of the end-of-session deal, Dukett said.

About 11,000 Mendocino County adults will be subject to the work rules, and about 3,000 of them could lose coverage, said Vicky Klakken, regional director for Partnership HealthPlan, the county’s Medi-Cal managed care plan. The plan’s Mendocino County membership fell by about 2,600 in the past year, to about 38,100 in July, Klakken said.

Nobody at the summit had a list of who those 11,000 are.

Under the rules, adults 19 to 64 who got Medi-Cal through the Affordable Care Act expansion must earn at least $580 a month, or put in 80 hours a month of work, school, job training, volunteering or a mix, unless they qualify for an exemption, according to the state Department of Health Care Services. Parents of children under 14, people with disabilities, people on Medicare and American Indians are among those exempt. The state began mailing letters to affected households Aug. 31, said Rachel Ebel-Elliott, the county’s deputy director of social services for employment and family assistance.

Supervisor Ted Williams said nonprofits have asked him whether they should be lining up volunteer hours. He hasn’t heard from anyone who needs them.

“What I don’t want is January or February, people show up to say they had no knowledge that they were about to lose services,” Williams said.

Asked what share of the affected residents know the rules are coming, Ebel-Elliott said, “probably not a very large portion.” The county can send text messages to people who have opted in, and it’s pushing the changes through social media and its community partners, Ebel-Elliott said.

Micheline White, executive director of the Mendonoma Health Alliance on the south coast, said of her clients, “I can almost guarantee you that close to all of them have no idea.”

Lucresha Renteria, executive director of Mendocino Coast Clinics, asked the county to share which of the clinics’ patients fall in the affected eligibility categories so the clinics can reach those families and match them with volunteer work. Peter McNamee of the Grassroots Institute, speaking by Zoom during public comment, urged the county to build a system that lets nonprofits plug people into volunteer work and count the hours toward their coverage. Karen Shepherd of Consolidated Tribal Health Project said she would ask the tribes about offering volunteer slots, and Jesse VanVoorhis, the county’s deputy director for adult and aging services, said the department has started calling senior centers and food banks to build a list of places that need volunteers.

The county Department of Social Services got notice Aug. 28 of a $9.6 million Medi-Cal administrative allocation, including $1.6 million in one-time money for the H.R. 1 changes that must be spent by July 1, 2027, Director DeDe Parker said. The department plans to spend it on technology, temporary staff and outside training rather than permanent positions, and will return to the board in a month or two with a staffing plan, Parker said.

The county’s Medi-Cal caseload has grown from about 8,400 households in December 2013 to more than 20,000 in July, and the number of adults covered has nearly tripled, Ebel-Elliott said. Starting with renewals due in March 2027, those adults will have their eligibility checked every six months instead of once a year.

The federal law also cost the county its CalFresh work-requirement waiver. Five people have lost food benefits since June because they hit the program’s limit of three months of benefits in a 36-month period, and 101 more are expected to lose them Oct. 1, Ebel-Elliott said.

Seniors and people with disabilities face a separate change. The Medi-Cal asset limit, now $130,000 for a single person, drops to $21,000 on July 1, 2027, and $31,000 for a couple, according to the state. A home and one vehicle don’t count.

Renteria said 80% of the clinics’ dental patients are on Medi-Cal. “If we lost 10% of that, I can’t afford to have a dental clinic anymore,” Renteria said. A visit that pays the clinics about $250 through Medi-Cal brings in about $20 on the sliding fee scale, Renteria said.

Richard Riter, chief financial officer for Adventist Health’s North Coast network, said the emergency rooms at the county’s three hospitals have seen a shift of a couple of percentage points from Medi-Cal to uninsured since January, a year before the work rules start.

Bronwyn Golly, emergency medical services chief of the Coast Life Support District, which runs the ambulances from Irish Beach to Fort Ross, said Medi-Cal fee-for-service pays a flat $118 for a transport, whether it starts in Ukiah or runs from Gualala to Santa Rosa. A federal subsidy that lifts that to about $1,100 for public providers is on the chopping block, Golly said. The district has Measure D on the November ballot to raise its parcel tax to $101 per unit of benefit, which needs two-thirds approval. If it fails, “We’ll be looking at how we can change our service model,” Golly said.

Supervisor John Haschak asked whether the rural counties’ group is pressing Congress to undo the law. It is, Dukett said, but major changes are unlikely before 2030. Darcie Antle, the former county chief executive officer who convened the first summit a year ago, asked the board to hold another in a year.

Residents with questions about their Medi-Cal can call the county’s Fort Bragg eligibility office at 707-962-1000 or the Ukiah office at 707-463-7700, or manage their case at benefitscal.com, according to the Department of Social Services.