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Interactive tracker of how H.R. 1, state budget cuts, and policy changes are impacting FQHCs, undocumented populations, and community health programs.
Reviewed June 30, 2026 · State budget signed June 29; UIS-PPS and dental cuts deferred to July 2027
$30B
Annual Medi-Cal Cuts
per year cut from California's Medi-Cal program under H.R. 1
1.7M
Undocumented Enrolled
undocumented immigrants currently enrolled in Medi-Cal facing coverage changes
3.4M
Could Lose Coverage
Californians at risk of losing Medi-Cal coverage due to federal and state changes
$308M
Dental Cuts (Year 1)
saved by eliminating dental coverage for undocumented adults — at the cost of preventive care
$1.2B
CalAIM Funding at Risk
in ECM + Community Supports funding at risk when the CalAIM waiver expires Dec 2026
1,400+
Health Centers at Risk
community health centers nationally face revenue shortfalls from Medicaid restructuring
Board pack
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Each point marks a policy change affecting community health centers and their patients.
Congress enacts the largest Medicaid funding reduction in the program's 60-year history, cutting nearly $1 trillion from Medicaid nationwide.
California freezes full-scope Medi-Cal enrollment for new undocumented applicants aged 19+. Existing enrollees retain coverage if they complete annual renewal. New enrollment limited to emergency and pregnancy-related care only.
Originally slated for July 1, 2026, this cut was delayed 12 months to July 1, 2027 in the 2026-27 California budget signed June 29, 2026. When it takes effect, full-scope dental benefits are removed for Medi-Cal members aged 19+ with unsatisfactory immigration status — undocumented individuals, DACA recipients, TPS holders, asylum applicants, U visa applicants, and lawful permanent residents in the 5-year waiting period.
Originally slated for July 1, 2026, this ~$1B cut was delayed 12 months to July 1, 2027 in the 2026-27 California budget signed June 29, 2026, which maintains clinics' PPS for state-only Medi-Cal in 2026-27. When the cut takes effect, Prospective Payment System (PPS) rates — the enhanced reimbursement FQHCs rely on — are eliminated for state-only-funded services to undocumented individuals, and FQHCs instead receive lower Medi-Cal Fee Schedule rates.
Under H.R. 1, nondisabled, childless adults on Medicaid must comply with new community engagement (work) requirements. States can add work requirements that may cause eligible people to lose coverage due to paperwork errors.
H.R. 1 reduces the FMAP (Federal Medical Assistance Percentage) from 90% to California's standard rate for emergency medical services to undocumented immigrants. Emergency coverage remains but at lower federal match.
The Community Health Center Fund — roughly 70% of federal Section 330 grant dollars (~$4.6B/yr) and the financial foundation beneath every FQHC's PPS billing — expires December 31, 2026, the same day as CalAIM and the Medi-Cal MCO tax. As of mid-2026 no standalone reauthorization bill had been introduced; the likely vehicle is a year-end appropriations or reconciliation package. NACHC's ask is a multi-year extension plus $950M/yr in mandatory NHSC funding.
California's CalAIM 1115 waiver expires Dec 31, 2026, but the threat has narrowed: DHCS formally submitted the renewal to CMS on May 11, 2026 (proposed term Jan 2027 – Dec 2031) and confirmed ECM and most Community Supports continue under standalone managed-care authority regardless of waiver timing. Residual risk is the services that specifically depend on 1115 authority, plus whatever conditions CMS attaches at approval. CalAIM funds ECM ($956M) and Community Supports ($231M).
Undocumented Medi-Cal members aged 19-59 who are not pregnant must pay a $30 monthly premium to retain full-scope coverage. Those who cannot pay may lose coverage.
H.R. 1 reduces retroactive coverage from 3 months to 2 months (1 month for expansion adults). This means more medical debt for low-income patients and more uncompensated care for providers.
ACA expansion adults face up to $35 copays for "non-essential" services. FQHCs, behavioral health clinics, and rural health clinics are exempt from these copays.
Health programs being eliminated, reduced, frozen, or put at risk.
California's historic expansion of full Medi-Cal coverage to all income-eligible adults regardless of immigration status, enacted via AB 133 (2021) and expanded through 2024.
Full-scope dental benefits for Medi-Cal members aged 19+ with unsatisfactory immigration status. Includes preventive, restorative, and emergency dental care.
Enhanced Prospective Payment System reimbursement rates that FQHCs receive for serving Medi-Cal patients. PPS rates average $200-400/visit vs. $80-120 on the standard fee schedule.
CalAIM's flagship care coordination program for highest-need Medi-Cal members. Funds CHWs, care coordinators, and patient navigators at FQHCs. $956M annual budget.
CalAIM benefit providing housing navigation, medically tailored meals, and other social determinants of health services. $231M annual budget. Federal administration has signaled opposition to social-services-oriented Medicaid spending.
California's provider tax mechanism that generates $7-8 billion in federal Medicaid matching funds annually. H.R. 1 limits provider taxes starting January 2026, potentially undermining this critical funding source.
How these changes affect the bottom line for community health centers.
Provider payment caps under H.R. 1 will edge rates downward from current levels toward substantially lower Medicare levels starting in 2028.
Current Revenue
60-80% of FQHC revenue
Projected Loss
10-25% reduction
17% loss
State budget eliminates PPS rates for undocumented patient services. FQHCs reimbursed at standard fee schedule instead — a 50-70% cut per visit.
Current Revenue
$200-400/visit
Projected Loss
Reduced to $80-120/visit
60% loss
Signed-budget dental reductions for undocumented adults now sit in a July 1, 2027 planning horizon pending implementation guidance. FQHCs still need to model whether sliding-fee dental capacity can absorb any future loss.
Current Revenue
10-15% of FQHC revenue (for those with dental)
Projected Loss
Near-total loss for undocumented patients
85% loss
If the CalAIM waiver is not renewed, ECM and Community Supports funding could be cut or restructured. CHW and care coordinator positions funded by these programs are at highest risk.
Current Revenue
$1.2B statewide
Projected Loss
Uncertain — waiver expires Dec 2026
40% loss
H.R. 1 ("One Big Beautiful Bill") cuts nearly $1 trillion from Medicaid nationally — the largest cut in the program's 60-year history. It restructures eligibility, adds work requirements, and imposes copays that will push millions off coverage.
California faces a $12 billion budget deficit. The Medi-Cal expansion for undocumented adults (costing ~$5 billion/year fully state-funded) became a primary target for cuts. Governor Newsom prioritized preserving existing coverage over new enrollment.
The federal administration has signaled opposition to Medicaid spending on social services like housing navigation and medically tailored meals. Federal guidelines supporting these uses were rescinded in March 2025. The CalAIM waiver funding ECM and Community Supports expires December 2026.
Levers that cities and counties can use to protect healthcare access.
Counties can create locally-funded health coverage programs for residents excluded from Medi-Cal. LA County's My Health LA program serves 200,000+ uninsured residents through FQHCs.
Cities and counties can levy or increase local taxes on tobacco, sugary beverages, or cannabis with revenue dedicated to community health services and FQHC funding.
Non-profit hospitals must provide community benefit to maintain tax-exempt status. Cities can negotiate agreements directing hospital community benefit funds to FQHCs and community health programs.
FQHCs can maximize 340B savings by expanding contract pharmacy networks and using savings to cross-subsidize care for unfunded patients. Cities can support this through technical assistance.
Even with federal cuts, California can maintain or increase state-only funding to bridge the gap. The state can use General Fund dollars to continue reimbursing FQHCs at PPS rates for undocumented patients.
Primary sources and reports used in this tracker.
How Massive Federal Cuts Will Create Unprecedented Challenges for Medi-Cal
California Health Care Foundation · October 15, 2025
H.R. 1 and the Federal Budget: How California Leaders Can Respond
California Budget & Policy Center · September 1, 2025
CalAIM ECM and Community Supports Implementation Update
CA Legislative Analyst's Office · March 6, 2025
Newsom Proposes to Freeze Medi-Cal Enrollment for Undocumented Immigrants
CalMatters · May 14, 2025
California Governor Signs $321B Budget After Deal to Delay Healthcare Cuts
Associated Press · June 30, 2026
California DHCS H.R.1 Implementation Plan
CA Dept. of Health Care Services · January 29, 2026
The State of Health Coverage in California: Progress, Disparities, and Policy Threats
California Budget & Policy Center · December 1, 2025
Valley Hospitals, Clinics Brace for Financial 'Tsunami'
Hanford Sentinel · January 15, 2026
The Future of Enhanced Care Management: Why CalAIM Must Be Protected
Presidium Health · November 1, 2025
Medi-Cal Changes and What You Need to Know
Health Consumer Alliance · December 15, 2025
Editorial analysis and intelligence summaries do not constitute legal, medical, financial, tax, or regulatory advice. Always consult qualified professionals and primary sources before acting on anything you read here.
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