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H.R. 1 and California’s Public Health Care Systems

Overview

H.R. 1 includes significant changes to Medicaid financing and eligibility that will affect health care providers, states and patients across the country. For California’s public health care systems, the law is expected to reduce federal funding, increase administrative requirements and place additional pressure on providers that care for large numbers of Medi-Cal and uninsured patients.

California’s 17 public health care systems serve 3.4 million patients annually and provide a disproportionate share of the state’s Medi-Cal, uninsured and specialty care services. CAPH is working with members, state leaders and federal policymakers to understand the full impact of H.R. 1 and advocate for solutions that protect access to care. 

Key Provisions

H.R. 1 includes several provisions that affect Medicaid funding and coverage, including:

  • Changes to Medicaid eligibility and enrollment requirements
  • More frequent eligibility redeterminations
  • New work requirements for certain Medicaid beneficiaries
  • Changes to retroactive coverage policies
  • Restrictions on Medicaid state directed payments

These changes will be implemented over several years, with many of the most significant provisions taking effect between 2027 and 2028.

What It Means for California

Public health care systems play a unique role in California’s health care landscape. They provide a significant share of care for Medi-Cal beneficiaries and uninsured patients while also operating critical services such as trauma, burn and behavioral health programs.

As H.R. 1 is implemented, public health care systems may face substantial financial and operational challenges. CAPH continues to monitor federal guidance, assess the impact on California’s public health care systems and advocate for policies that preserve access to care for the communities they serve.

Additional Resources

For additional information on H.R. 1 and its impact on California’s public health care systems, download CAPH’s H.R. 1 fact sheet and visit our Federal Advocacy page.