Sacramento County Projects 73,000 to Lose Medi-Cal Coverage Next Year — Patient Surge Signal for Sacramento FQHCs

Sacramento County DHHS estimates 73,000 residents will lose Medi-Cal coverage in the next 12 months due to H.R. 1-driven eligibility changes (six-month redeterminations by Dec 31, 2026), the new $30/mo UIS premium starting July 2027, and the federal admin match cut from 50% to 25% (Oct 2026). Direct implication for Sacramento's 11 FQHCs (2,196 staff, 319K patients): a meaningful share of the 73K disenrolled will keep showing up for care, but as uninsured rather than Medi-Cal — increasing uncompensated care exposure. Most affected: WellSpace Health (largest BH+primary care footprint), Sacramento Native American Health Center, One Community Health (HIV-focused), Elica Health Centers, and The Effort. Strategic implications: (1) update FY26-27 charity care budget assumptions, (2) accelerate patient outreach for redetermination support, (3) negotiate MCP capitation rates that reflect rising churn, (4) consider Sliding Fee Scale rate adjustments. The May Revise (mid-May) is the next state-level signal for whether the county estimate will hold or worsen.