CSAC + CWDA Counties Demand $6.4B from the State Post-May Revise, Sharp Public Pushback Over the 'State Responsibility' Cost-Shift
Following Governor Newsom's May 14 May Revise, California State Association of Counties CEO Graham Knaus issued sharp public pushback: counties want $6.4B over two years to backfill Medi-Cal coverage losses, hospital support, and BH services. Knaus' quote: 'The governor proposes to hide from state responsibility while demanding counties do the state's job for free.'
County-by-county requests align with prior figures: Sacramento County (Lutz) wants $1.9B FY26-27 + $4.5B FY27-28; Fresno County is $241M indigent care exposed (already tracked); LA County preserves DPH via $63.2M new ongoing local funds plus reserve drawdowns. CSAC/CWDA may litigate or block budget elements.
Affects ALL counties operating clinic systems: LA DHS, AHS (Alameda), SF DPH, Sacramento DHS, San Diego HHSA, Riverside RUHS, Ventura County HCA, Monterey County Health, Santa Cruz HSA, San Bernardino DBH.
Strategic implication for FQHCs:
- county Medi-Cal cost-shifts will likely translate to reductions in county-FQHC contracts (ECM, CalAIM Community Supports, BH crisis services)
- FQHCs serving as residual safety-net for closed county clinics will absorb uninsured volume
- align CPCA/CCALAC advocacy with CSAC/CWDA testimony in June 15 budget conference committee window.
Part of
- California's budget, the MCO tax and Proposition 35
The annual budget
Key points
- CSAC + CWDA demand $6.4B over 2 years — counties may sue or block budget elements
- Knaus: 'governor proposes to hide from state responsibility while demanding counties do state's job for free'
- Affects all 58 CA counties — LA DHS, AHS, SF DPH, Sac DHS, SD HHSA, Riverside RUHS, etc.
- Align CPCA/CCALAC + CSAC/CWDA testimony in June 15 conference committee window
Sources for this story
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FQHC Talent. (2026, May 14). CSAC + CWDA Counties Demand $6.4B from the State Post-May Revise, Sharp Public Pushback Over the 'State Responsibility' Cost-Shift. Source: CalMatters / CSAC. Retrieved September 28, 2026, from https://www.fqhctalent.com/intel/csac-cwda-counties-6-4b-demand-may-revise-may-14-2026
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