Trump’s ‘One Big Beautiful Bill’ Threatens Santa Barbara County with $11 Million a Year in New Indigent Care Costs

Estimated 4,500 People Now Receiving Medi-Cal in Santa Barbara Will Cease to Be Eligible Once Budget Bill Goes into Effect Later This Year

Cottage Hospital’s Emergency Room | Credit: Paul Wellman File Photo

When Donald Trump’s so-called One Big Beautiful Bill (a k a HR 1) goes into effect later this year, it will require the County of Santa Barbara to reactivate its long-dormant Indigent Care Program at an estimated cost to the county of $11.4 million a year.

California law requires county governments to provide care for the medically indigent — those who are uninsured and unable to pay for their own care. When the Affordable Care Act was passed in 2010, however, Santa Barbara County — like all 58 counties — found itself off the hook. Medi-Cal, as part of the Affordable Care Act, stepped in to provide such care. But under HR 1, many Medi-Cal beneficiaries will no longer qualify for Medi-Cal, because either they don’t meet work requirements or other new eligibility standards imposed by HR 1.

Supervisor Bob Nelson | Credit: Ingrid Bostrom File Photo

CenCal — which administers Medi-Cal in Santa Barbara and San Luis Obispo counties — estimates 4,500 people now receiving Medi-Cal in Santa Barbara will cease to be eligible. This means the county will have to reactivate its Indigent Care Program.

County Public Information Officer Kelsey Buttitta stressed that indigent care should not be confused with anything resembling a health insurance policy and does not provide the same level of benefits available through Medi-Cal or the Affordable Care Act marketplace.

“It provides only the services necessary to prevent serious harm, pain, or infection,” she stated. Some patients might require “urgent surgeries or cancer treatment,” she noted, while others might need “diabetes control or hypertension management.”

In the past, the state legislature — through its budget — covered the cost of indigent care that counties absorbed. There was no provision in the governor’s budget for this added cost and nothing in the governor’s May Revise budget released earlier this month.

Last week, Supervisor Bob Nelson — the board chair — drove to Sacramento to discuss this problem with state legislatures. “You can’t change things if you’re not in the room,” he said. Nelson said he met with Assemblymember Gregg Hart, that Hart was interested, and that some ideas were discussed. Nothing specific, however, has been proposed, let alone finalized.