May 13th, 2026
The Honorable Jesse Gabriel
Chair, Assembly Budget Committee 1021
O Street, Room 8230
Sacramento, CA 95814
The Honorable Dawn Addis
Chair, Assembly Budget Subcommittee No. 1 on Health and Human Services
1021 O Street, Suite 4120
Sacramento, CA 95814
RE: Support for Orange County H.R. 1 Budget Investments: County Indigent Care, Medi-Cal & CalFresh Eligibility Workforce, and Behavioral Health
Dear Chair Gabriel and Chair Addis:
I write to request budget investments to address the significant local impacts associated with H.R. 1 and the resulting pressures on county-operated safety net systems. As federal reductions to Medicaid and nutrition assistance programs continue to shift costs and responsibilities to local governments, counties like Orange County are increasingly being asked to absorb growing service demands without the resources necessary to do so effectively.
Orange County anticipates substantial impacts from H.R. 1, including increased demand for indigent health care services, higher behavioral health caseloads, and significant administrative workload increases tied to Medi-Cal and CalFresh eligibility changes.
Preliminary estimates indicate these combined impacts could exceed $396 million annually in Orange County alone. Nearly 850,000 Orange County residents rely on Medi-Cal and nearly 300,000 residents receive CalFresh benefits. As residents lose access to coverage and benefits, counties remain legally and morally responsible for ensuring vulnerable individuals can still access medically necessary care and essential services.
I respectfully urge the Legislature to prioritize requested investments in indigent care services, county eligibility workforce administration, behavioral health programs, and local public health infrastructure in the 2026-27 state budget. These investments are critical to helping counties manage increased caseloads, prevent further strain on emergency rooms and crisis systems, and maintain continuity of care for low-income residents, seniors, children, and individuals with behavioral health needs.
This request for indigent care funding reflects the reality that many counties significantly reduced or restructured indigent care infrastructure following the Affordable Care Act’s Medi-Cal expansion. As coverage losses now increase under H.R. 1, counties must rapidly rebuild capacity to provide care for uninsured residents while simultaneously managing broader fiscal pressures tied to inflation, Proposition 36 implementation, and other state and local obligations.
Thank you for your leadership during this challenging budget year and for your continued commitment to protecting California’s safety net systems. I respectfully request your consideration of these budget requests as part of ongoing budget negotiations.
Sincerely,
Assemblymember Diane Dixon Assembly District 72
