California's Budget Funds Public Hospitals and Enrollment but Zero for Indigent Care — Sonoma County Projects CMSP Caseload Could Jump From 97 to ~11,560

California's enacted FY2026-27 budget provides $250 million for public hospitals and $420 million for benefits-enrollment staffing, but $0 for the mandated indigent-care costs counties must absorb as H.R. 1's Medicaid changes phase in.

The California State Association of Counties (CSAC) had sought $50 million for the fiscal year that began July 1 and $462 million for 2027-28; CSAC CEO Graham Knaus said flatly, 'There is zero in the state budget related to indigent care.' Sonoma County — which in May estimated a three-year, $39.6 million indigent-care cost including its County Medical Services Program (CMSP, the safety net for people who don't qualify for Medi-Cal) — projects per April estimates that its CMSP caseload could balloon from 97 people today to roughly 11,560 as coverage losses hit.

Local clinics have asked the county for $12 million to prepare for the coming wave of uninsured patients; county officials are holding off on committing funds until next year's full H.R. 1 impact is clearer.