San Joaquin County officials say President Trump’s big beautiful bill could reduce funding for local health care and safety-net programs by tens of millions of dollars annually, potentially straining hospitals, public health programs and social services.
County leaders estimate the legislation — formally known as the One Big Beautiful Bill Act, or H.R.1 — could reduce federal revenue to San Joaquin County by $50.9 million to $76.9 million annually, according to a presentation delivered to the Board of Supervisors on March 3.
The law, signed July 4, 2025, is a federal budget measure that includes changes to taxation, Medicaid, food assistance and other social service programs. Local officials say some of those policy changes could shift financial and administrative responsibilities to counties, which already operate hospitals, administer public health programs and determine eligibility for safety-net benefits.
President Donald J. Trump, who signed the legislation into law, promoted the measure as a “major tax and policy overhaul.” In a post on social media, Trump said the bill would cut taxes and restrict Medicaid eligibility for certain groups.
“Republicans must unite behind the ‘One Big Beautiful Bill,’” Trump wrote. “Not only does it cut taxes for all Americans, but it will kick millions of illegal aliens off of Medicaid to protect it for those who are the ones in real need.”
Supervisor Sonny Dhaliwal, chair of the San Joaquin County Board of Supervisors, said the county departments most exposed to funding reductions include the Health Care Services Agency, San Joaquin General Hospital and the Human Services Agency.
“Counties do the hard work,” Dhaliwal said. “We run the hospitals, protect public health, care for vulnerable children and keep families fed. H.R.1 shifts costs to the county and adds administrative responsibility for several programs, resulting in a loss of money coming to the county for services and increasing the cost of services already provided. That is not sustainable.”
The county’s analysis indicates the Health Care Services Agency could lose between $30.4 million and $34.4 million annually, while San Joaquin General Hospital could face losses ranging from $11 million to $30.8 million.
The Human Services Agency could see an additional $9.4 million to $11.7 million in funding changes tied to Medi-Cal and CalFresh program administration.
County Administrative Officer Sandy Regalo said the changes could create long-term fiscal pressure for counties that administer state and federal programs.
“This bill creates a structural funding gap for counties,” Regalo said. “These are not discretionary programs. Counties are required by the state and federal governments to provide indigent health care, public health protection and safety-net services. When federal funding is reduced, the costs do not disappear — they shift directly onto local budgets.”
Lizeth Granados, chief executive officer of Health Plan of San Joaquin — the largest Medi-Cal managed care provider in the county — said eligibility changes could ripple across the region’s health care system.
“It’s going to have a big impact on the overall health care system in San Joaquin County,” Granados said. “Roughly 40 percent of residents are eligible for Medi-Cal services. As membership begins to decline, we will have a greater portion of the community uninsured.”
“Without access to preventive care services, people may wait until their condition becomes urgent before seeking treatment,” she said. “That puts additional strain on the health care system.”
Health officials say the changes could also affect how residents access care.
Richard Castro, chief executive officer of San Joaquin General Hospital, said the public hospital will continue treating patients regardless of their ability to pay but warned that the policy changes could increase demand for emergency services.
“Individuals who were covered by Medi-Cal will now be ineligible, and they will be in our emergency room instead of with their primary care providers,” Castro said. “This impacts everyone we serve.”
Public Health Director Renee Sunseri said the law raises broader concerns for community health in the county.
“Our residents rely on Medi-Cal and CalFresh to access health care, medications and nutritious food — services that are fundamental to preventing disease and keeping communities healthy,” Sunseri said. “Unfunded mandates will increase and delay access to care and create inappropriate use of critical resources necessary to keep residents alive.”
Human Services Agency Director Chris Woods said reductions in program enrollment do not necessarily mean fewer residents need assistance.
“Reductions in enrollment do not reflect reduced need,” Woods said. “What we will see instead is churn. Families lose benefits, reapply and cycle back into the system. That delays access to food and health care, increases administrative costs and puts more strain on safety-net programs.”
County data show 314,058 San Joaquin County residents are enrolled in Medi-Cal, representing about 39 percent of the county’s population, while 131,891 residents participate in CalFresh food assistance programs.
Dhaliwal said the county has maintained a structurally balanced budget for more than a decade but may need assistance from state and federal officials to address the projected funding gap.
“For our residents that means local services being cut to fund required federal programs, potentially worse health outcomes for those without access to primary care, and longer wait times for ambulance service and at the hospital,” he said.
Granados said federal Medicaid funding is critical to maintaining stability in local health care systems and warned that policy changes can ripple through both providers and patients.
“Federal funding for these programs is essential to ensuring continuity of care for residents,” she said. “When those funding streams change, it affects not only the health care system and providers but also the individuals who depend on timely access to care.”
Rep. Josh Harder, who represents California’s 9th Congressional District in the U.S. House of Representatives — including Stockton, Tracy, Lodi and much of San Joaquin County — criticized the measure, saying it could strip health coverage from vulnerable residents while shifting the financial burden onto local governments and hospitals.
“This is the biggest health care cut in a generation, and I’m outraged,” Harder said. “Parents won’t be able to take their kids to the doctor, seniors won’t be able to afford their medication, and thousands of our neighbors are going to get kicked off of their insurance. All to fund another round of billionaire handouts and devastating attacks by ICE on our community. I’m going to fight tooth and nail to reverse these cuts and hold Washington accountable for trying to tear away our health care.”