medi-cal

SACRAMENTO — Top California health officials warned that federal cuts will deliver a devastating blow to public health, even as the state grapples with ways to mitigate the damage.

“These changes will impact our emergency departments, rural hospitals, private and public hospitals, community health centers, ambulance providers and the broader health care system that serves every community,” said Michelle Baass, director of the California Department of Health Care Services.

Baass was among several experts who spoke Monday at a briefing about the effects of HR 1, a massive tax and spending bill passed by the Republican-led Congress and signed by President Trump that shifts federal funding away from safety-net programs for the vulnerable and toward tax cuts and immigration enforcement. She said the legislation makes sweeping changes to Medi-Cal, as Medicaid is known in California.

It “will cause widespread harm by making massive reductions in federal funding and potentially cripple the health care safety net,” Baass said. “These changes put tens of billions of dollars of federal funding at risk for California and could result in a loss of coverage for millions of Californians.”

Roughly 15 million Californians — a third of the state — are on Medi-Cal, with some of the highest percentages being in rural counties. More than half of the children in California receive healthcare coverage through Medi-Cal, healthcare coverage provided to eligible, low-income residents, according to the state Department of Health Care Services.

California officials expect the state to lose billions of dollars in federal funding for Medi-Cal and other essential healthcare programs. Given that California is facing an ongoing budget deficit, it is highly unlikely that the state will be able to raise enough money to make up for the loss in funding to continue the current level of services to residents, according to a report by the state Legislative Analyst’s Office.

Baass explained the federal legislation creates new eligibility requirements for Medicaid. Starting in 2027, many individuals ages 19 to 64 will need to work for at least 80 hours a month, or perform 80 hours of community service or be enrolled in an educational program, to qualify. The law allows various exemptions, including pregnancy, disabilities, or caring for children under the age of 19.

She estimated 3 million Medi-Cal recipients could lose coverage as a result.

“This would significantly drive up the uninsured rate that raises cost for hospitals treating uninsured patients,” Baass said.

Baass said HR 1, which Republicans labeled the “Big, Beautiful Bill,” also bans abortion providers from receiving federal Medicaid funding — even for healthcare services they offer that are not related to the procedure — and reduces federal dollars for emergency medical care for undocumented immigrants. It additionally limits state funding mechanisms, such as taxes paid by managed care providers, and establishes federal penalties for improper payments.

CalFresh, the state name for the Supplemental Nutrition Assistance Program, is expecting cuts of at least $1.7 billion annually, said Jennifer Troia, director of the California Department of Social Services. About 395,000 people could lose their benefits for government food assistance.

SNAP benefits are also being hit by the current government shutdown, with payments halting in November.

At the heart of the shutdown is a political standoff in Washington over the expiring tax credits for people who get health insurance through the Affordable Care Act, also known as Obamacare. Democrats said they will not vote to reopen the government until Republicans agree to renew the expanded subsidies. Republican leaders refused to negotiate until Democrats vote to reopen the government.

Covered California, the state’s Affordable Care Act health insurance marketplace, estimated over the summer that as many as 660,000 of the roughly 2 million people in the program will either be stripped of coverage or drop out because of increased cost and the onerous new mandates to stay enrolled.

Impacts from the new federal cuts and policies are already being felt across the state and nation.

A Planned Parenthood program in Orange and San Bernardino counties announced its imminent closure earlier this month due to being federally defunded. Los Angeles County’s health system has implemented a hiring freeze and is bracing to lose $750 million per year for the county Department of Health Services, which oversees four public hospitals and roughly two dozen clinics. Meanwhile, food banks nationwide are seeking donations and preparing for longer lines.

Kim Johnson, secretary of the state Health and Human Services Agency, discussed how California is fighting back.

Gov. Gavin Newsom recently announced he is deploying the National Guard and fast-tracking $80 million to support food banks, she said. This came alongside the governor’s decision to allocate $140 million in state funding to Planned Parenthood.

Johnson said Atty. Gen. Rob Bonta has filed more than two dozen lawsuits related to HR 1.

“Here in California,” she said, “we will continue to mitigate the harm of these federal changes wherever we can.”

SACRAMENTO — Though raging thousands of miles to the east, the entrenched stalemate in Washington over federal spending and the ensuing government shutdown has thrust California’s expansive healthcare policies into the center of the pitched, partisan debate.

The Trump administration and the Republican leaders in Congress continue to use California, and the benefits the state has extended to eligible immigrants regardless of their legal status, as a cudgel against Democrats trying to extend federal subsidies for taxpayer-funded healthcare coverage.

President Trump claimed recently that Democrats “want to have illegal aliens come into our country and get massive healthcare at the cost to everybody else.” Democrats called Trump’s assertion an absolute lie, accusing Republicans of wanting to slash federal healthcare benefits to Americans in need to pay for tax breaks for the wealthy.

“California has led the nation in expanding access to affordable healthcare, but Donald Trump is ripping it away,” California Gov. Gavin Newsom said.

In return for their votes to reopen the government, Democratic leaders in Congress want to reverse Medicaid cuts made in Republicans’ tax and spending bill passed this summer and continue subsidies through the Affordable Care Act, a program long targeted by Republicans. The subsidies, which come in the form of a tax credit, help lower health insurance costs for millions of Americans.

Can immigrants in the country illegally enroll in federal healthcare programs?

No. Undocumented immigrants are ineligible for Medicaid, Children’s Health Insurance Program or Medicare, or coverage through the Affordable Care Act, according to KFF, an independent health research organization.

Rep. Kevin Mullin (D-South San Francisco) held a virtual town hall last week in which he highlighted the “misinformation” about immigrants and healthcare.

“I just want to be completely clear that federal funding does not pay for health insurance for undocumented immigrants, period,” Mullin said.

Jessica Altman, executive director of Covered California, said the debate is really over “who can benefit from the federal dollars that are flowing to all states, including California,” to help lower costs for health insurance.

Covered California serves as a marketplace exchange for state residents seeking healthcare insurance under the Affordable Care Act, widely known as Obamacare, allowing them to select from name-brand insurance providers and choose from a variety of coverage plans. The vast majority of Californians receive federal subsidies to lower their premiums, including many middle-income families who had become eligible when Congress expanded the financial assistance in 2021.

Those expanded subsidies will expire at the end of the year, and Democrats are demanding that they be extended as part of any deal to reopen the government before they vote in favor of what is known as a continuing resolution, or a temporary funding bill to keep the federal government running.

“From the very beginning, undocumented or illegal — whatever terminology you want to use — individuals were never eligible for those tax credits, never eligible for those cost-sharing reductions, and in fact, and not even eligible to come onto a marketplace and buy coverage if they paid the full costs,” Altman said.

California does offer state healthcare coverage for undocumented immigrants

Through Medi-Cal, the state’s version of the federal Medicaid program, some medical coverage is offered, regardless of immigration status. The majority of that money comes from the state.

H.D. Palmer, deputy director for external affairs at the California Department of Finance, said the cost to provide Medi-Cal to undocumented immigrants in the current fiscal year is just over $12.5 billion.

State money accounts for $11.2 billion and the remaining difference is reimbursed with federal funding because it’s used to cover emergency services, Palmer explained.

“Under current law, hospitals that receive Medicaid are required to provide emergency care, including labor and delivery, to individuals regardless of their citizenship status,” he said. “That goes back to a budget law that was approved by Congress in 1986 and signed by President Ronald Reagan.”

The 1986 law is called the Emergency Medical Treatment and Active Labor Act, and allows for emergency healthcare for all persons.

Some Republicans have raised other concerns about the state’s use of managed care organization taxes.

The MCO tax is a federally allowable Medicaid funding mechanism that imposes a tax on health insurance providers that charge fixed monthly payments for services and is based on the number of people enrolled in plans each month. The revenue from the tax can then be used to support Medicaid expenditures with federal matching funds.

Critics say California exploits a so-called loophole: By increasing the MCO tax, and subsequently bringing in more matching federal funds, California can then put more of its own state money toward healthcare for undocumented immigrants.

“We are bringing in all those additional federal dollars and then reallocating other money away so that we can provide about $9.6 billion for Medi-Cal for undocumented and illegal immigrants,” said Assemblymember David J. Tangipa (R-Fresno). “The MCO tax was never supposed to be weaponized in that process.”

White House officials also contend that California could not afford to put resources toward benefits for undocumented immigrants if it had not received the extra federal money — a claim Newsom disputes.

“What the president is saying, he’s lying,” Newsom said at a recent event. “Speaker [Mike] Johnson’s lying. They’re lying to the American people. It’s shameful. … I guess they’re trying to connect their displeasure with what California and many other states do with state resources in this space, and that is a very separate conversation.”

California is not alone in offering such healthcare to immigrants in the country illegally

A “small but growing” number of states offer state-funded coverage to certain groups of low-income people regardless of immigration status, according to KFF.

California became the first state in the nation last year to offer healthcare to all low-income undocumented immigrants, an expansion spearheaded by Newsom.

Newsom has since partially walked back that policy after the costs exceeded expectations. Starting in January, most adult Medi-Cal applications will be blocked — although current enrollees can continue to renew — and some adults will be required to pay monthly premiums. Undocumented minors under age 19, who became eligible for Medi-Cal nearly a decade ago, will not be affected by the changes.

The upcoming changes to the state’s policies and the enrollment freeze will help decrease the overall costs, which are projected to fall to about $10.1 billion during the next fiscal year, according to the California Department of Finance.

While the governor’s shift angered his most progressive allies and renewed speculation that he is tacking to the political middle ahead of his expected run for president in 2028, the Democratic-led Legislature approved the Medi-Cal eligibility changes in June.

Public opinion on the issue may also be changing.

Fifty-eight percent of adults in California were opposed to providing healthcare for undocumented immigrants, according to a poll released in June from the nonpartisan Public Policy Institute of California. This was a notable shift, as previous surveys from the institute conducted between 2015 to 2023 showed the majority approved.

Who would lose coverage if the tax credits end and Medicaid cuts aren’t reversed?

Trump’s One Big Beautiful Bill Act, passed by Republicans this summer, ends healthcare subsidies that were extended during the pandemic and makes other cuts to programs. According to the White House, the bill “contains the most important America First healthcare reforms ever enacted.”

“The policies represent a comprehensive effort to address waste, fraud, and abuse to strengthen the healthcare system for the most vulnerable Americans, ensuring that taxpayer dollars are focused on American citizens and do not subsidize healthcare for illegal immigrants,” the White House said in a statement on Oct. 1.

Among other things, the law limits Medicare and other program eligibility to certain groups, including green card holders, effective July 2025. Other lawfully present immigrants, including refugees and asylees, are no longer eligible, according to KFF.

It’s estimated that the eligibility restrictions will result in about 1.4 million lawfully present immigrants becoming uninsured, reduce federal spending by about $131 billion and increase federal revenue by $4.8 billion as of 2034, according to the Congressional Budget Office.

At the same time, a broader group of lawfully present immigrants, including refugees, will lose access to subsidized coverage through the ACA marketplace by January 2027.

Covered California’s Altman estimated that there are about 119,000 immigrants in California who are covered and would lose eligibility for financial assistance.

More broadly, Altman and other healthcare experts predict that healthcare premiums will skyrocket if the ACA tax credits expire.

Of all the finger-pointing and recriminations that come with the current federal government shutdown, one of the most striking elements is that the Trump administration blames it on Democratic support for granting taxpayer-funded healthcare coverage to undocumented immigrants. The White House has called out California specifically, saying the state exploits a legal “loophole” to pay for that coverage with federal dollars, and other states have followed suit.

“California utilized an egregious loophole — since employed by several other states — to draw down federal matching funds used to provide Medicaid benefits for illegal immigrants,” the White House said in a policy memo released Wednesday as a budget stalemate forced a shutdown of the U.S. government.

The administration said that the Working Families Tax Cut Act, which goes into effect in October 2026, closes the loophole by prohibiting the use of taxpayer money to provide healthcare coverage to undocumented immigrants and other noncitizens.

In the memo, the White House accused congressional Democrats of wanting to repeal those policy reforms as a condition to keep the government running.

Izzy Gardon, a spokeswoman for Gov. Gavin Newsom, said there’s nothing to the administration’s underlying assertion that California and other states have found some sort of loophole that enables them to funnel Medicaid money to noncitizens.

“This is false — CA does not do this,” Gardon said in a one-line email to the L.A. Times.

Healthcare policy experts agree. California is not exploiting a “loophole,” said Adriana Ramos-Yamamoto, a senior policy analyst at the California Budget & Policy Center, a nonprofit, nonpartisan organization that studies inequality.

“The state is making lawful, transparent budget choices to invest in health coverage with its own dollars,” Ramos-Yamamoto said in a statement to The Times. “These investments improve health outcomes, strengthen communities, and lower health care costs in the long run.”

At issue is Section 71117 of the Republican-backed “One Big Beautiful Bill Act,” which imposes nearly $1 trillion in reductions to federal Medicaid healthcare spending for low-income Americans over the next 10 years. The provision allows states “to finance the non-federal share of Medicaid spending through multiple sources, including state general funds, healthcare related taxes (or ‘provider taxes’), and local government funds,” as long as taxes on healthcare providers are imposed uniformly so as not to unfairly burden providers of Medicaid services.

The bottom line, analysts said, is the administration is citing a problem with the law that doesn’t seem to exist, at least not in California.

“The so-called California loophole references a provision in the law that ends a waiver of the uniformity requirements for provider taxes — this provision has nothing to do with using federal funds to pay for care for undocumented immigrants,” said Jennifer Tolbert, a healthcare expert at the nonprofit healthcare research, polling and news organization KFF.

“But the White House makes the claim that California uses the money they get from the provider tax to pay for care for undocumented immigrants,” Tolbert said.

Fact-checking the administration’s claim is all the more difficult because there are no official data on how states spend money collected from provider taxes, Alice Burns, another KFF analyst, added. What’s more, California is among several states that offer some level of Medicaid coverage to all immigrants regardless of status. And because California cannot be federally reimbursed for healthcare spending on people who are not in the country legally, those expenses must be covered at the state level.

The White House memo goes on to claim that if Democrats were to succeed at repealing the provisions in the Working Families Tax Act, the federal government would have to spend an additional $34.6 billion in taxpayer money “that would continue to primarily be abused by California to fund healthcare for illegal immigrants.”

This assertion also misconstrues the facts, according to KFF.

“What we do know is that the $35 billion in savings that is referenced in the White House Fact Sheet refers to the federal government’s estimated savings … resulting from states making changes to their provider tax systems,” KFF spokesperson Tammie Smith said. That is, the projected savings aren’t connected to healthcare for immigrants living in the U.S. illegally.

Political squabbling aside, California’s approach to medical coverage for low-income, undocumented immigrants is set to undergo a major shift thanks to provisions in the 2025-26 state budget that the Democrat-led legislature and Newsom approved in June.

Starting on Jan. 1, adults “who do not have Satisfactory Immigration Status (SIS)” will no longer be able to enroll in Medi-Cal, California’s Medicaid program, according to the state’s Department of Health Care Services webpage. Those who already have this coverage can keep it and continue to renew their enrollment. And starting on July 1, Medi-Cal enrollees who are age 19-59, undocumented and not pregnant will have to pay a $30 monthly premium to keep their coverage.

The changes, which Newsom called for in the spring to offset a ballooning Medi-Cal budget deficit, drew criticism from some immigrant rights groups, with the California Immigrant Policy Center describing the moves as “discriminatory.”

“In light of the militarized mass immigration raids and arrests causing fear and chaos across California, we are disappointed that the governor and the leadership in the Legislature chose to adopt a state budget that makes our communities even more vulnerable,” Masih Fouladi, the center’s executive director said at the time.

Everyone in California who qualifies for Medi-Cal will still be eligible to receive emergency medical and dental care, no matter their immigration status.

The nation’s first mandated work requirement for Medicaid recepients, approved by the Republican-led Congress and signed by President Trump, is expected to have a seismic effect in California.

One estimate from state health officials suggests that as many as 3.4 million people could lose their insurance through what Gov. Gavin Newsom calls the “labyrinth of manual verification,” which involves Medi-Cal recipients proving every six months that they are working, going to school or volunteering at least 80 hours per month.

“It’s going to be much harder to stay insured,” said Martha Santana-Chin, the head of L.A. Care Health Plan, a publicly operated health plan that serves about 2.3 million Medi-Cal patients in Los Angeles County.

She said that as many as 1 million people, or about 20% to 40% of its members, could lose their coverage.

The work requirement will be the first imposed nationwide in the six-decade history of Medicaid, the program that provides free and subsidized health insurance to disabled and low-income Americans.

It’s relatively uncharted territory, and it’s not yet clear how the rules will shake out for the 5.1 million people in California who will be required to prove that they are working in order to qualify for Medi-Cal, the state’s version of Medicaid.

After the 2026 midterm elections, millions of healthy adults will be required to prove every six months that they meet the work requirement in order to qualify for Medicaid. The new mandate spells out some exceptions, including for people who are pregnant, in addiction treatment or caring for children under age 14.

Democrats have long argued that work requirements generally lead to eligible people l osing their health insurance due to bureaucratic hurdles. Republicans say that a work requirement will encourage healthy people to get jobs and preserve Medicaid for those who truly need it.

“If you clean that up and shore it up, you save a lot of money,” said House Speaker Mike Johnson of Louisiana. “And you return the dignity of work to young men who need to be out working instead of playing video games all day.”

Only three U.S. states have tried to implement work requirements for Medicaid recipients: New Hampshire, Arkansas and Georgia. One study found that in the first three months of the Arkansas program, more than 18,000 people lost health coverage.

People can lose coverage a variety of ways, said Joan Alker, a Georgetown University professor who studies Medicaid. Some people hear that the rules have changed and assume they are no longer eligible. Others struggle to prove their eligibility because their income fluctuates, they are paid in cash or their jobs don’t keep good payroll records. Some have problems with the technology or forms, she said, and others don’t appeal their rejections.

Of the 15 million people on Medi-Cal in California, about one-third will be required to prove they are working, the state said. Those people earn very little: less than $21,000 for a single person and less than $43,000 for a household of four.

The state’s estimate of 3.4 million people losing coverage is a projection based on what happened in Arkansas and New Hampshire.

But those programs were brief, overturned by the courts and weren’t “a coordinated effort among the states to figure out what the best practices are,” said Ryan Long, the director of congressional relations at the Paragon Health Institute, a conservative think tank that has become influential among congressional Republicans.

Long said advancements in technology and a national emphasis on work requirements should make work verification less of a barrier. The budget bill includes $200 million in grants for states to update their systems to prepare, he said.

Arguments from liberal groups that people will lose healthcare are a “straw man argument,” Long said: “They know that the public supports work requirements for these benefits, so they can’t come out and say, ‘We don’t support them.’”

A poll by the health research group KFF found this year that 62% of American adults support tying Medicaid eligibility to work requirements.

The poll also found that support for the policy drops to less than 1 in 3 people when respondents hear “that most people on Medicaid are already working and many would risk losing coverage because of the burden of proving eligibility through paperwork.”

In June, Newsom warned that some Californians could be forced to fill out 36 pages of paperwork to keep their insurance, showing reporters an image of a stack of forms with teal and gold accents that he described as “an actual PDF example of the paperwork that people will have to submit to for their eligibility checks.”

Many Californians already are required to fill out that 36-page form or its online equivalent to enroll in Medi-Cal and Covered California, the state’s health insurance marketplace.

Experts say it’s too soon to say what system will be used for people to prove their work eligibility, because federal guidance won’t be finalized for months.

Newsom’s office directed questions to the Department of Health Care Services, which runs Medi-Cal. A spokesperson there said officials are “still reviewing the full operational impacts” of the work requirements.

“The idea that you are going to get a paper submission every six months, I’m not sure people have to do that,” Long said.

Georgia is the only state that has implemented a lasting work requirement for Medicaid. Two years ago, the state made healthcare available to people who were working at least 80 hours per month and earned less than the federal poverty limit (about $15,000 for one person or $31,200 for a household of four).

More than 100,000 people have applied for coverage since the program’s launch in July of 2023. As of June of this year, more than 8,000 people were enrolled, according to the state’s most recent data.

The Medicaid program has cost more than $100 million so far, and of that, $26 million was spent on health benefits and more than $20 million was allocated to marketing contracts, KFF Health News reported. Democrats in Georgia have sought an investigation into the program.

The Inland Empire agency that provides Medi-Cal coverage for about 1.5 million people in San Bernardino and Riverside counties estimated that 150,000 members could lose their insurance as a result of work requirements.

Jarrod McNaughton, the chief executive of the Inland Empire Health Plan, said that California’s 58 counties, which administer Medi-Cal, “will be the ones at the precipice of piecing this together” but haven’t yet received guidance on how the eligibility process will be set up or what information people will have to provide.

Will it be done online? Will recipients be required to fill out a piece of paper that needs to be mailed in or dropped off? “We don’t really know the process yet, because all of this is so new,” Naughton said.

In the meantime, he said, the health plan’s foundation is working to make this “as least burdensome as possible,” working to improve community outreach and connect people who receive Medi-Cal insurance to volunteer opportunities.

Los Angeles County’s health system, which is responsible for the care of the region’s poorest, is careening toward a financial crisis because of cuts from a presidential administration and Republican-led Congress looking to drastically slash the size of government.

President Trump’s “Big Beautiful Bill,” which passed earlier this month, is expected to soon claw $750 million per year from the county Department of Health Services, which oversees four public hospitals and roughly two dozen clinics. In an all-staff email Friday, the agency called the bill a “big, devastating blow to our health system” and said a hiring freeze had gone into effect, immediately.

And the Trump administration’s budget for the next fiscal year will likely result in a $200-million cut to the county Department of Public Health, whose responsibilities include monitoring disease outbreaks, inspecting food and providing substance use treatment.

“I’m not going to sugarcoat it. I’m not going to say we survive this,” said Barbara Ferrer, head of the public health department, in an interview. “We can’t survive this big a cut.”

Both Ferrer and Department of Health Services head Christina Ghaly warned that the federal cuts will devastate their agencies — and the patients they serve — for years to come. Employee layoffs are likely.

In April, the White House announced it was ending infectious disease grants worth billions of dollars, including $45 million that L.A. County was supposed to use to combat the spread of measles and bird flu. California has joined other states in a lawsuit fighting the cuts, and the court has issued a preliminary injunction suspending the cuts.

A protest earlier this month in Anaheim, co-led by the California Nurses Assn., called on Rep. Young Kim (R-Anaheim Hills) to vote against President Trump’s spending bill.

(Allen J. Schaben/Los Angeles Times)

This month, the county public health department lost another $16 million after Trump’s bill cut funding for a program educating food stamp recipients about how to buy healthy meals.

And there’s more to come. The Trump administration’s proposed budget for 2026 will be the biggest blow yet, Ferrer warned, yanking $200 million from her department — a 12% cut.

“I’m old. I’ve been around for a long time,” said Ferrer, whose work in public health dates back to the Reagan administration. “I’ve never actually seen this much disdain for public health.”

Ferrer said the cuts mean she no longer has enough money for the county’s bioterrorism watch program, which monitors for outbreaks that might signal a biological attack. Soon, she said, county officials may have to stop testing ocean water for toxins year round, cutting back to just half the year.

“Like, you want to swim? You want to know that the water is safe where you swim, then oppose these kinds of cuts,” she said. “That affects everybody who goes to the beach.”

L.A. County Public Health Director Barbara Ferrer said she is bracing for $200 million in cuts to her budget.

(Al Seib/Los Angeles Times)

Layoffs are likely, said Ferrer. About 1,500 public health staffers are supported through federal grants. More than half the federal money the department receives is funneled to outside organizations, which would likely need to make cuts to stay afloat.

A similarly grim cost analysis is underway at the county Department of Health Services, where executives said they expect to lose $280 million this fiscal year because of the bill.

“I can’t make a promise that we will be able to avoid layoffs because of the magnitude of the challenges,” said Ghaly.

Ghaly said the bill slashed the extra Medicaid money the county typically gets to cover care for low-income patients. They expect many patients might be kicked off Medicaid because of new eligibility and work requirements. The federal government is pulling back on payments for emergency services for undocumented people, meaning the county will have to foot more of the bill.

The White House did not respond to a request for comment.

Department of Health Services officials said they expect to lose $750 million per year by 2028. By then, the agency’s budget deficit is projected to have ballooned to $1.85 billion.

In an attempt to pump more cash into the system, L.A. County supervisors voted on Tuesday to increase a parcel tax first approved by voters in 2002, which is expected to raise an additional $87 million for the county’s trauma care network.

After a long debate Tuesday, Supervisors Holly Mitchell and Lindsey Horvath worked to direct $9 million of the parcel tax money to Martin Luther King Jr. Community Hospital, a private hospital that serves as a critical safety net for South Los Angeles residents who would otherwise find themselves in a medical desert.

Without that cash infusion from the county, the cuts in Trump’s bill would have put the hospital at risk of closing, since the majority of patients in its emergency room are on Medicaid, said Elaine Batchlor, Martin Luther King’s chief executive officer.

“If they’ve lost their Medicaid coverage, we simply won’t get paid for those patients,” she said.

Dr. Elaine Batchlor, chief executive of MLK Community Healthcare, said her hospital was hanging by a thread financially. Then came more cuts.

(Francine Orr/Los Angeles Times)

Martin Luther King replaced a county hospital that closed after losing national accreditation in 2005 because of serious medical malpractice, landing it the nickname “Killer King.”

“The fact that that hospital closed in the first place I think is criminal, and I intend to do all I can to protect the integrity of the services,” said Mitchell, whose district includes the hospital and who pushed for it to get a cut of money from the parcel tax increase.

Local health providers said that changes at the state level have created additional uncertainty. The state budget for this fiscal year freezes enrollment in Medi-Cal, California’s version of Medicaid, for undocumented immigrants ages 19 and older starting in January. Medi-Cal recipients ages 19 to 59 will have to pay a $30 monthly premium beginning July 1, 2027.

“Most families [we serve] are making about $2,400 to $2,600 a month. They’re going to have to choose between paying their Medi-Cal fees for a family of four — that’s $120 a month — or paying rent or paying for food,” said Jim Mangia, head of St. John’s Community Health, who said the cuts will disrupt care for tens of thousands of low-income residents.

The St. John’s clinic, which gets most of its revenue from Medi-Cal reimbursements, serves more than 120,000 patients a year, most of whom live below the federal poverty line.

If the clinic doesn’t find a way to replace the lost revenue, Mangia warned, services will have to be reduced. The clinic recently started treating immigrant patients in their homes after realizing they had been skipping appointments because they feared being arrested by federal immigration agents.

“Then what we’re looking at is closing several health centers,” said Mangia. “We’re looking at laying off hundreds of staff.”

At Venice Family Clinic, a community health center that serves nearly 45,000 patients annually, 80% of patients rely on Medi-Cal. Roughly half the clinic’s revenue comes from Medi-Cal reimbursements.

Dr. Mitesh Popat, a family physician and head of the clinic, said that federal policy changes — especially more frequent paperwork and added work requirements — will likely push eligible patients off of Medi-Cal. He said the clinic is exploring ways to expand support for patients to navigate the paperwork and keep their coverage.

“This puts a bunch of barriers in the way of people who already have enough challenges in life,” Popat said. “They’re trying to make it, trying to survive, trying to put food on the table.”

Protesters railed on Tuesday against an Orange County congresswoman who could be a critical vote on President Trump’s proposal to cut more than $1 trillion in federal dollars that helped pay for healthcare for those in need and extend tax cuts for millions of Americans.

Trump’s proposed “One Big Beautiful Bill Act” narrowly passed the U.S. Senate hours before hundreds of people gathered in a cul-de-sac outside of the Anaheim field office of Republican Rep. Young Kim to protest those cuts. The legislation still needs to be voted on by the U.S. House of Representatives, which could happen before the end of the week.

“I don’t know why they call it beautiful, because there’s nothing about it that’s beautiful. It’s harmful, it’s reckless, and it’s cruel, and it’s going to hurt people,” said Melody Mendenhall, a nurse at UCLA who is active with the California Nurses Assn., which was among the groups that organized the protest. “Rep. Young Kim, hear our cry, hear our voices. We need our Medicaid. We cannot afford this type of reckless cuts and behavior.”

A security guard blocked the parking lot to Kim’s office and at least a half-dozen Anaheim police officers watched the protest unfold.

Several people who appeared to be Kim staffers watched the demonstration from outside the building before they dashed inside when protesters marched to the building, unsuccessfully sought to enter it and then began chanting “Shame! Shame!”

In a statement, Kim said that her door was always open to Californians in her district.

“I understand some of my constituents are concerned and know how important Medicaid services are for many in my community, which is why I voted to protect and strengthen Medicaid services for our most vulnerable citizens who truly need it,” Kim said. “I have met with many of these local healthcare advocates in recent months.”

Trump’s proposal would dramatically overhaul the nation’s tax code by making cuts approved during the president’s first term permanent, a major benefit to the corporations and the nation’s wealthy, while slashing funding for historic federal safety-net programs including Medicaid and the Supplemental Nutrition Assistance Program, which helps provide food to low-income Americans.

Roughly 15 million Californians, more than a third of the state, are on Medi-Cal, the state’s version of Medicaid, with some of the highest percentages in rural counties that supported Trump in the November election. More than half of California children receive healthcare coverage through Medi-Cal.

A version of the Republican bill was passed by the U.S. House of Representatives with Kim’s support. The U.S. Senate narrowly approved an amended version of the bill on Tuesday. The defection of three GOP senators meant Vice President JD Vance had to cast the tie-breaking vote for it to pass in that chamber.

The House and Senate will now work to reconcile their two different versions of the bill. This week was a district work week for members of Congress, but House Speaker Mike Johnson (R-Louisiana) ordered members back to Washington, D.C., for votes on the bill that could occur Wednesday or Thursday.

Republicans hope to get the legislation to President Trump’s desk for his signature by Friday, Independence Day, though there is some concern among its members about whether they will have enough votes to pass the bill because of potential defections and the united Democratic opposition.

An analysis released by the nonpartisan Congressional Budget Office on Sunday estimated that the Senate version of the proposal would increase the national deficit by nearly $3.3 trillion from 2025 to 2034 and would result in 11.8 million Americans losing health insurance in less than a decade.

Trump praised the passage of the bill on social media and urged House Republicans to support the Senate plan.

The proposal has caused a rift within the GOP, with and some House members have expressed reservations about the measure because of the amount it would add to the nation’s deficit and its impact on their constituents.

“I’ve been clear from the start that I will not support a final reconciliation bill that makes harmful cuts to Medicaid, puts critical funding at risk, or threatens the stability of healthcare providers” in his congressional district, Rep. David Valadao (R-Hanford) wrote on the social media site X on Sunday.

He represents more than half a million Central Valley residents who rely on Medicaid — the most of any congressional district in California, according to the UC Berkeley Labor Center. A spokesperson for Valadao on Tuesday didn’t respond to a question about how the congressman planned to vote.

Kim’s Orange County district is more affluent than Valadao’s, but roughly one in five of her constituents relies on Medicaid.

The congresswoman was en route to Washington at the time of the protest, according to a spokesperson.

Outside her Anaheim field office, protester after protester described how the bill would impact vulnerable Californians, such as disabled children, the elderly, veterans and those who would lose access to reproductive healthcare.

“The stakes have never been higher. We are living in a time when our rights are under attack,” said Emily Escobar, a public advocacy manager for Planned Parenthood of Orange and San Bernardino Counties.

She said that federal funds do not pay for abortions, but help pay for other vital healthcare, such as cancer screenings, preventative care, testing and treatment for sexually transmitted infections and access to contraception. More than one-third of Planned Parenthood’s patients nationwide reside in California.

These cuts will result in clinics being shut down, effectively reducing access to abortion, Escobar said.

“Let me make this clear, this bill is a backdoor abortion ban,” she said.

Shari Home, 73, said she and her husband were weighing how to divide their Social Security income on food, medication and medical supplies after her husband, who suffers several chronic health conditions, fell last year.

“The hospitalizations were so expensive, so we applied for and got Medi-Cal in January and food assistance, and it’s been such a lifesaver,” said the Laguna Woods resident. “Without Medi-Cal, I don’t know what we would do. Our lives would not be good. We would not have the medications that he needs.”

Michelle Del Rosario, 57, wore a button picturing her son William, 25, on her blouse. The Orange resident, one of Kim’s constituents who has previously voted for her, is the primary caregiver for her son, who has autism, epilepsy and does not speak.

Her son relies on his Medi-Cal coverage for his $5,000-a-month seizure medicine, as well as the home health support he receives, she said.

“He lives at home. He has desires, at some point, to live independently, to work, but he needs” these support services for that to happen, Del Rosario said.