H.R. 1 Creates a Looming Crisis for Fresno County Families
Across Fresno County, health is tied directly to the land, our work, and our families.
Our communities feed the nation, labor in packing plants, build neighborhood infrastructure, and drive the Central Valley economy. Yet, our families contend daily with persistent air quality burdens, chronic health conditions, and lower life expectancies in disinvested zip codes.
For nearly half of Fresno County residents, Medi-Cal and CalFresh keep life afloat. It is the guarantee that an asthmatic child can see a pediatrician, a field worker can treat heat exhaustion, and a family has fresh groceries on the table between harvest seasons.
Now, sweeping federal policy shifts under H.R. 1 threaten to unravel the public support systems our families rely on. A policy brief from Catalyst California, Mending the Social Safety Net: H.R. 1’s Impact on California Counties, demonstrates that while H.R. 1 reshapes safety-net programs statewide, Fresno County is at the center of its most destabilizing fiscal and human impacts.
Disproportionate Need and Racial Disparities
A total of 508,465 residents are certified eligible for Medi-Cal—affecting up to 515,398 total enrollees—and more than 250,000 residents participate in CalFresh each month.
In plain human terms:
- One in every two Fresno County residents relies on Medi-Cal.
- One in four relies on CalFresh.
According to Catalyst California’s RACE COUNTS equity data hub, there are 49,545 uninsured Latinx residents in Fresno County, compared to 10,751 uninsured White residents, a racial gap that reflects how lack of access to care disproportionately falls along racial and ethnic lines.
The Projected Fallout of H.R. 1
As tighter eligibility verifications, frequent redeterminations, and expanded work-reporting mandates take hold, the projected toll on Fresno County families is devastating:
- 27,000 Residents Risk Losing Medi-Cal: Projections from the UC Berkeley Labor Center indicate that approximately 27,000 Fresno County residents could be stripped of their health coverage by 2028 due to procedural hurdles and new reporting mandates.
- 17,900 Residents at Risk of Losing CalFresh: The California Association of Food Banks estimates that federal reductions in food assistance will impact nearly 18,000 residents across the county.
- A $43 Million Economic Drain: CalFresh dollars circulate through our neighborhood economy. With the average participant receiving roughly $200 per month ($2,385 annually), kicking nearly 18,000 people off the program represents a loss of $43 million every year that previously supported local supermarkets, neighborhood bodegas, and Central Valley farmers’ markets.
A $300 Million Deficit Meets Escalating Indigent Care Costs
Federal rollbacks do not eliminate people’s medical needs; they simply eliminate the funding to pay for them. Patients without insurance will inevitably delay care until manageable illnesses escalate into emergencies, transferring an immense unfunded burden onto local emergency rooms and county-run indigent care programs.
Meanwhile, Fresno County is currently facing an estimated $300 million budget deficit.
Unlike wealthier coastal counties with large tax bases and deeper reserves, Fresno has very few options to offset these shortfalls. In response, county leadership has already instructed departments to implement 5 percent spending reductions across the board for the FY 2026–27 budget.
The county’s legal obligations under the indigent care program are projected to climb to between $40 million and $240 million in Fresno County alone.
County leaders have mobilized alongside a statewide coalition to seek relief, initially requesting $1.9 billion from Sacramento to help local governments weather H.R. 1 cost shifts. However, the Governor’s May Revise offered only $87 million in county aid statewide, an amount local leaders warn falls dangerously short.
While counties are now urging the California Legislature to back reconciliation legislation establishing a two-year, $250 million emergency indigent care fund, Fresno County Chief Administrative Officer Paul Nerland put the challenge into stark perspective:
The county’s obligations for the indigent care program are estimated to range between $40 million and $240 million… just in Fresno County. The state putting aside $250 million for the whole state over two years is a start, but it’s a drop in the bucket compared to the costs we will face.
At Fresno Building Healthy Communities, we understand that health is a human right, deeply intertwined with racial, economic, and geographic justice. This looming crisis touches every pillar of our work. Stripping $43 million in food benefits will deepen childhood hunger in agricultural neighborhoods that harvest our country’s food. Balancing a county budget by slashing vital health and human services will cripple our community’s safety net.
H.R. 1 threatens to shift massive costs to jurisdictions with the highest poverty rates, the greatest need, and the least local revenue to absorb the blow. If California allows Fresno County to bear these costs alone, existing geographic and racial inequities will widen for generations.
The report highlights that the primary driver of coverage losses under H.R. 1 will not necessarily be changes in family income, but procedural disenrollments, specifically losses caused by missed paperwork deadlines, complex verification requirements, and frequent redeterminations.
For Fresno County, this creates an administrative nightmare:
- The Digital and Broadband Divide: Tens of thousands of rural residents from San Joaquin and Firebaugh to Huron and Orange Cove lack reliable high-speed internet to manage online account portals.
- Unstable Mail and Working Schedules: Farmworkers and mobile laborers frequently shift locations during harvest cycles or lack dedicated physical mailing addresses, causing renewal notices to go unreceived.
- Language Access Gaps: Notices filled with complex bureaucratic jargon frequently fail to provide adequate translations, locking eligible families out of their benefits.
Potential Next Steps
Mitigating the harm of H.R. 1 will require an aggressive, coordinated strategy:
- State-Level Revenue and Allocation Reform: Sacramento must establish progressive state revenue solutions and allocate emergency safety-net stabilization funds based on community need and county fiscal vulnerability, not local wealth.
- Administrative Automation: Fresno County DSS and state health departments must maximize automated renewals by cross-referencing existing data systems to verify eligibility without burying residents in redundant paperwork.
- Equitable Investment in Trusted Navigators: Rather than relying solely on automated online portals or overburdened county call centers, the state and philanthropy must fund local community-based organizations to deploy trusted navigators into neighborhoods to help residents directly.
If you want to provide immediate help in your community, reach out to three family members, neighbors, or co-workers who rely on Medi-Cal or CalFresh. Urge them to log into their account or visit the Fresno County Department of Social Services to make sure their physical mailing address, phone number, and household information are fully up to date. Keeping your records current is the single most effective way to prevent losing coverage simply due to a missed letter.
Together, we can inform our neighbors and hold public systems accountable to ensure every Fresno family thrives.
To learn more about local campaigns, community workshops, and how you can get involved in advocating for health equity across Fresno County, subscribe to our newsletter.
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