Central Valley, CA (November 14, 2025) — The chairwoman of the California State Assembly’s Health Committee said changes to the federal Medicaid health insurance program for low-income residents could strip as many as 400,000 San Joaquin Valley residents of medical coverage over the coming decade.
Provisions of House Resolution 1, the “One Big Beautiful Bill Act” backed by President Donald Trump and passed by Congress in July, Assemblymember Mia Bonta, D-Oakland, said, will be “devastating” to California’s Central Valley region by imposing greater work requirements, higher cost-sharing, and more frequent eligibility checks for enrollees in Medicaid – known as Medi-Cal in California
Bonta was joined by Assemblymember Esmeralda Soria, D-Fresno, at a roundtable conference of hospital representatives, health clinic operators and public health officials on Nov. 10 in downtown Fresno to listen to concerns about what H.R. 1 and the possible expiration of Affordable Care Act tax credits or subsidies will mean for the region. It is one of a series of such meetings that Bonta is convening throughout California between late October and early January.
“We know in California there’s going to be about $30 billion dollars in federal Medi-Cal funding at risk annually” from H.R. 1, Bonta said, “(and) 3.4 million Californians are projected to lose coverage.”
“In the Central Valley here … between 200,000 to 400,000 residents across the Central Valley will lose medical coverage by 2034,” she added.
Soria, whose 27th Assembly District includes portions of Fresno, Madera and Merced counties, said the federal legislation adds to the Valley’s existing burden of high poverty and hardship, as well as a lack of health care providers.
“Today was kind of a sobering reminder that the Central Valley and our region is already starting at a deficit,” Soria said. “And then it’s compounded by the actions of HR 1 and the lack of resources that are coming into our community.”
“These impacts are going to be catastrophic to our region,” she added. “That’s why everyone showed up (for the roundtable) and talked about, ‘What are some of the local impacts, what are some of the state impacts, and what can we do together to leverage those resources?’”
H.R. 1 includes more than $1 trillion in cuts to Medicaid between now and 2034. Among the key Medicaid provisions:
● A rule that states impose a work or service requirement of at least 80 hours per month for people ages 19 to 64 to be eligible for Medicaid. Parents of children age 13 and under, and people who are medically frail, are exempt from the work requirement.
● A requirement to begin charging $35 per service for covered adults for certain services in 40 states, including California, where Medicaid coverage was expanded under the Affordable Care Act.
● A requirement that states reassess Medicaid eligibility every six months for people covered under Medicaid expansion. Current law calls for eligibility renewal every 12 months.
● A limit on retroactive Medicaid coverage to costs that occur either one or two months prior to a person’s application for coverage. Current law includes retroactive coverage going back three months.
● Bars Medicaid funds from being paid to nonprofits that primarily provide family planning or reproductive services, including abortions, and received $800,000 or more in Medicaid payments in 2023.
● A restriction on Medicaid eligibility for some lawful immigrants who are eligible under current law. Those who will no longer be eligible include refugees, people who have been granted asylum and abused spouses and children. Current law bars undocumented immigrants from eligibility for federally-funded Medicaid coverage.
Medicaid isn’t the only social safety-net program that was targeted for cuts in HR 1. The bill also slices about $287 billion from the federal Supplemental Nutrition Assistance Program over the same 10-year period. The weight of those cuts is likely to be felt most deeply by households with the lowest incomes, according to the Congressional Budget Office.
About 482,000 households amounting to more than 950,000 people across Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus and Tulare counties receive assistance through CalFresh, as SNAP is known in California. The program used to be commonly referred to as “food stamps.”
Separately from H.R. 1, the fate of an expanded layer of tax credits or subsidies to help people pay for health insurance premiums under the federal Affordable Care Act remains in limbo. Those credits are set to expire at the end of 2025 unless Congress votes to extend them.
In San Joaquin Valley counties, about 202,000 people were enrolled as members of Covered California as of July. Of those, about 91% have their costs at least partially subsidized by tax credits.
President Donald Trump and Republicans in Congress remain at loggerheads with Democratic legislators over extending the credits – a dispute largely at the heart of a federal government shutdown that began Oct. 1 as the two parties failed to agree on a stop-gap spending bill to keep the government open. After 43 days, the House of Representatives on Wednesday followed the lead of the U.S. Senate to end what had become the longest shutdown in U.S. history. But it came without any concrete action on the ACA tax credits.
“Essentially, families who are under Covered California will essentially experience anywhere between two to three times as much in premium costs as a result of the removal of the subsidies,” Bonta said.
The federal cuts come at a time when California is also grappling with its own financial constraints dealing with Medi-Cal.
California expects to spend almost $197 billion on Medi-Cal in the current 2025-26 budget year, according to the state Health and Human Services Agency. Well over half of that will come from the federal Medicaid program.
But in the face of budget woes, California is tightening its purse strings for Medi-Cal, particularly from the general fund portion of the state’s overall budget.
The new state budget adopted by the California Legislature, which took effect July 1, incorporates several significant provisions that will limit or eliminate some health services for residents with “unsatisfactory immigration status” – bureaucratic jargon for undocumented immigrants who are not eligible for federal Medicaid coverage.
“The state will certainly respond to this moment by making sure that we are stretching every dollar that we have allocated to health and basic needs as far as we can,” Bonta said.
But the combination of cuts to the federal Medicaid program, the state’s Medi-Cal efforts and worries over partial elimination of the ACA premium subsidies is creating fears over a surge in the number of people in the San Joaquin Valley and statewide who won’t have any form of health insurance.
“That was, I think, the number one local concern about enrollment decline that all of the stakeholders around the table pretty much mentioned,” Soria said after Monday’s meeting.
The roundtable meeting reflects an ongoing effort within the Valley’s healthcare community to collaborate with each other and with the state to confront the upcoming challenges.
“I think our community is trying to prepare for the worst … and hope for the best, but I think we do need to just be ready,” Soria said.
“And then the stakeholders here will have to figure out too, what are the things that they can do at the local level, to leverage resources, to collaborate, to make things more efficient,” Soria added, “and figure out a mechanism so that every single person does get the type of care that they need in our community,”
Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at [email protected]
