Federal legislation could cause hundreds of thousands of San Diegans to lose access to food and health care while costing San Diego County an additional $30 million to administer the safety net programs.
County staff on Tuesday presented those estimates to the Board of Supervisors, which voted 4-1 to have staff work on a plan to respond to the federal cuts. The board asked that staff have the plan ready to discuss in September.
The cuts are the product of a President Donald Trump and Republican-backed federal spending law, known as the “Big Beautiful Bill.” The new law made large cuts to Medicaid, the federal health insurance program that sends money to the states, including to Medi-Cal in California, and the Supplemental Nutrition Assistance Program, or SNAP, which provides money to help people buy groceries. CalFresh distributes federal funding that allows recipients to purchase food on EBT cards.
County supervisors had mixed reactions to the estimated impacts on San Diegans.
“We have a massive, massive crisis on our hands,” Supervisor Terra Lawson-Remer said after the staff presentation. “We are going to need to really figure out what are we going to do, or we are going to have hundreds of thousands of San Diegans without health care, hundreds of thousands of San Diegans without food, in one of the wealthiest countries in the world.”
Supervisor Jim Desmond, the lone “no” vote on a motion to direct staff to prepare a plan to respond to the cuts, had a different take.
“We need to safeguard programs like SNAP for future generations,” Desmond said.
Noting that federal and state governments are facing tremendous funding challenges, he said, “cuts need to be made, but I don’t think these cuts are that draconian.” He added that people who can work should.
“This isn’t about taking food out of people’s mouths who actually need it,” he said.
Here is what the county staff projects the impact will be:
Impact on immigrants
Many immigrants who are in the country legally are no longer eligible for SNAP benefits and will be immediately kicked off, staff said. The county estimates 13,000 will lose access to CalFresh.
Then, starting in October 2026, about 75,000 immigrants in San Diego County will lose access to Medi-Cal.
The only immigrants who will be able to access Medi-Cal or CalFresh are permanent residents — green card holders — or immigrants from Cuba, Haiti, the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau.
Work rule to impact 400,000 San Diegans
While Medi-Cal and CalFresh had work requirements for many beneficiaries before the recent changes, many more people will soon have to show they are working at least 20 hours a week.
The requirements kick in immediately for SNAP, or CalFresh, and in 2027 for Medicaid, or Medi-Cal.
Previously, people older than 54 or who have dependents under the age of 18 were exempt from work requirements to receive benefits for more than three months. Most other able-bodied people had to meet the work requirements to get benefits.
Under the new law, work requirement exemptions apply to those over 65 or with dependents under 14.
The county estimates that the new work requirements will affect 327,000 people on Medi-Cal and 70,000 on CalFresh.
States and counties to pay more
County staff noted that California passed its budget just days before the law, H.R. 1, was adopted and did not include any provisions to respond to the federal legislation. It is still unclear to what extent additional costs for states will be passed down to counties.
The new law shifts some of the costs of paying for the food that recipients get from CalFresh to the states. San Diego County administers $1 billion in CalFresh benefits, so 15% cost-sharing would equate to $150 million a year for just San Diego County.
Under the new law, the county estimates it will have to spend an additional $15.8 million out of its own budget to run the program.
The county will need more staff to administer the programs
The new law requires the county to check at least twice as often to see whether recipients qualify for the program, which now has more demanding requirements. In order to do that the county projects it would need to spend at least $29.8 million to fund an additional 361 full time positions in order to maintain the current levels of service.
The county budget passed in June cut 44 of these positions.
