Contra Costa Health projects a $730 million five-year deficit, with its county hospital and 11-clinic network hit hardest

Contra Costa Health told the Board of Supervisors on August 25, 2026 that budget-balancing initiatives it has identified reduce its FY2026-27 deficit from $80 million to $10 million, but that federal and state policy changes leave a projected $730 million cumulative structural deficit through FY2030-31. The presentation lists $390 million in federal funding reductions through FY2030-31, led by the Global Payment Program for uninsured patients' primary and preventive care ($180 million), and $460 million in state funding changes, led by $350 million in primary care reimbursement lost when people without verified immigration status lose access to managed Medi-Cal on January 1, 2027, the same date about 47,500 members move to fee-for-service Medi-Cal.

It says the greatest impact falls on Contra Costa Regional Medical Center & Health Centers, whose 11 clinics provide primary care to 1 in 5 county residents, and projects up to 93,000 uninsured people by 2031. Of four options for the county hospital, including closing it to expand ambulatory care, the department's recommended path is a multi-specialty hospital that restores critical services, which it says will require additional budget-balancing measures; the Board accepted the report 5-0.