Sacramento County DHS Director: 73,000 Will Lose Medi-Cal, 6,500 Become Indigent County Responsibility — CSAC Asks State for $1.9B FY2026-27, $4.5B FY2027-28

Sacramento County DHS Director Timothy Lutz quantified the H.R. 1 cost-shift to county safety nets: 73,000 county residents will lose Medi-Cal coverage in the next year, with 6,500 becoming the county's indigent care responsibility — 'tens of millions of dollars' that the county must absorb. This is the precise pipeline that will drive uninsured walk-ins to WellSpace Health, Elica Health Centers, One Community Health, CommuniCare Health Centers, and Health for All. Through CSAC and CWDA, California's 58 counties are asking the state for $1.9B in FY2026-27 + $4.5B in FY2027-28 to offset the cost-shift. This ask is timed to the May 14 May Revise budget release. Strategic implication for Sacramento-region FQHCs: model FY2026-27 patient mix shift assuming +10-15% uninsured walk-ins, build a sliding-fee-scale capacity plan, document indigent-care subsidy gaps for county advocacy, and engage the CSAC ask through CPCA regional coalition channels. Counties without the state backfill will absorb the cost by cutting other public-health programs — meaning FQHCs lose contracts (CalAIM, BHCIP grants) AND gain uninsured volume simultaneously. Both edges of the squeeze hit at once.