Acting Chair of the County Board of Supervisors Terra Lawson-Remer and District 4 Supervisor Monica Montgomery Steppe introduced a new proposal today directing the County to prepare for anticipated federal cost shifts. The plan calls for proactive planning to mitigate the operational fallout of the “One Big Beautiful Bill Act” (H.R. 1), recently passed by the U.S. House of Representatives.

If enacted, the bill could shift hundreds of millions in costs onto counties like San Diego, requiring the County to absorb new responsibilities for programs that help residents stay healthy, housed, and fed.

“Our County budget is balanced for the moment but it doesn’t yet reflect the scale of what’s coming,” said Supervisor Lawson-Remer. “This bill doesn’t just change the math, it changes the workload, it changes the social contract we have with our most vulnerable residents. We can’t afford to wait until these cuts take effect to start preparing.”

As passed by the House of Representatives, the One Big Beautiful Bill Act would:

• Reduce the Federal Medical Assistance Percentage (FMAP) for Medicaid’s ACA expansion population, creating an estimated $10 million shortfall for behavioral health services alone;

• Require twice-yearly redeterminations and new work-reporting requirements for Medi-Cal eligibility, potentially disrupting coverage for nearly 900,000 San Diegans and significantly increasing administrative burden;

• Shift the costs of CalFresh food benefits and administrative costs further onto states and counties, potentially costing the County an additional $276 million if the State also passes down the costs at a time when over 400,000 County residents rely on the program.

While many of these changes would take place in phases beginning at the earliest in January 2026, the operational impact would begin far earlier—through increased workload, system strain, and the need to hire and train additional eligibility workers.

“By the time these cuts officially take effect, the harm will already be happening,” stated Supervisor Monica Montgomery Steppe. “Our systems are stretched thin as it is. If we don’t act now, it’s working families, seniors, and kids who will pay the price. That is unacceptable, and we have a moral obligation to prevent it.”

Parallel to H.R. 1, the President’s proposed HUD budget would eliminate or scale back several core housing programs, including HOPWA, Section 8 vouchers, Emergency Housing Vouchers, and housing support for low-income and HIV-positive residents, representing an estimated $20 million annual funding loss to the County.

At the state level, a proposed cap on hours for In-Home-Supportive-Services caregivers would impact over 7,000 caregivers in San Diego, threatening to cut in-home care for hundreds of seniors and people with disabilities and further burdening working families and leaving vulnerable residents without the support they need.

A Two-Step Plan for Readiness and Fiscal Strategy

The Supervisors’ proposal lays out a clear, two-step plan to ensure San Diego is ready when the changes hit:

• By July 22, the Chief Administrative Officer would report back with a staffing and operational readiness assessment, outlining:

  • How many additional Self-Sufficiency workers may be needed to process Medi-Cal and CalFresh under the new federal rules while maintaining fast wait times, 

  • A communications plan to prepare affected residents, and

  • Recommendations to avoid coverage delays or benefit loss.

• By September 30, staff will report back with a full fiscal analysis, identifying funding options to sustain services under increased demand and reduced federal support. Options may include one-time bridge funding by reforming the reserves policy, state and federal grants, and intergovernmental and philanthropic partnerships, and will provide additional insight into the necessity of new local revenue sources.

“Too often, the government is reactive. After the damage is done, we’re left wishing we had done more to prepare,” said Supervisor Montgomery Steppe. “Right now, we have a chance to act before the crisis hits, and we must take it, because failing our constituents is simply not an option.”

The proposal will be formally considered at the June 24, 2025, Board of Supervisors meeting, alongside the vote on the County’s Fiscal Year 2025–26 Operational Plan.

Supervisors emphasized that while the County cannot backfill every cut from Washington, it can and must act to avoid cascading service disruptions, especially in healthcare, food assistance, housing, and in-home care.

“This is about protecting people: plain and simple,” said Supervisor Lawson-Remer. “We can’t solve every problem coming out of Washington, but we can decide whether we’re going to be ready or not. This plan ensures we are.”

If approved, the July and September reports will guide urgent operational decisions and long-term funding strategies to ensure that San Diego County families continue to get the care, support, and stability they deserve.

To read the full proposal click HERE

To view the full press conference click HERE