Just days before a crucial midterm election that may shift the balance of partisan power in Congress, the Trump administration announced that it is awarding $233.6 million in rural health care funds to California.

The money is coming from the $50 billion Rural Health Transformation Program, part of a package of measures within H.R. 1, also called the One Big Beautiful Bill Act, backed by President Donald Trump and narrowly approved by the Republican-controlled Congress in July 2025.

The $50 billion, however, pales in comparison to the estimated $1 trillion in reduced health spending embedded in H.R. 1. 

KFF, an independent health news and policy organization, reported that Medicaid – the federal health-insurance program for low-income families and known as Medi-Cal in California – was projected to see spending reduced by $911 billion over 10 years, including about $137 billion in Medicaid spending in rural areas of the country.

As such, the law has been a major campaign point for Democrats seeking to flip seats now held by Republicans in the House of Representatives and the U.S. Senate in the Nov. 3 midterm election.

Those candidates include Randy Villegas, a Democrat from Visalia who is battling to unseat incumbent Rep. David Valadao, R-Hanford, in the hotly contested 22nd Congressional District. The district includes parts of Fresno, Kern, Kings, Madera and Tulare counties in the San Joaquin Valley. About 62% of people in the 22nd District receive Medicaid benefits – the second largest percentage of all Congressional districts nationwide, according to KFF.

The Valadao/Villegas race is currently rated as a toss-up by The Cook Political Report.

Neither the Trump administration nor the seven House Republicans from California whose statements were included in the Oct. 29 announcement made reference to H.R. 1 by bill number or the One Big Beautiful Bill Act by name, instead referring to it as the Working Families Tax Cuts Act.

H.R. 1’s changes to Medicaid include:

  • A rule that states impose a work or service requirement of at least 80 hours per month for people ages 19 to 64 to be eligible for Medicaid. Parents of children age 13 and under, and people who are medically frail, are exempt from the work requirement.
  • A requirement to begin charging $35 per service for covered adults for certain services in 40 states, including California, where Medicaid coverage was expanded under the Affordable Care Act.
  • A requirement that states reassess Medicaid eligibility every six months for people covered under Medicaid expansion. Previously, eligibility renewal was once a year.
  • A limit on retroactive Medicaid coverage to costs that occur either one or two months prior to a person’s application for coverage. Current law includes retroactive coverage going back three months.
  • A prohibition on Medicaid funds being paid to nonprofits that primarily provide family planning or reproductive services, including abortions, and received $800,000 or more in Medicaid payments in 2023.
  • A restriction on Medicaid eligibility for some lawful immigrants who were eligible under prior law. Those no longer eligible include refugees, people who have been granted asylum and abused spouses and children. Current law already bars undocumented immigrants from eligibility for federally-funded Medicaid coverage.

A new policy brief on the potential impacts of H.R. 1 in the San Joaquin Valley, released this month by the Central Valley Health Policy Initiative at California State University, Fresno, stated that while many of H.R. 1’s major health provisions don’t take effect until late 2026 or later, “the law’s burdens are expected to deepen economic disinvestment for low- and middle-income households.”

Between the end of some tax credits to subsidize health coverage purchased through the Affordable Care Act, and new Medicaid/Medi-Cal work requirements and more narrowly defined eligibility requirements, the Fresno State brief forecasts that “many residents are expected to rely on emergency departments for primary care.”

The brief also indicates that more limited access to health care for low-income residents is “likely to increase preventable hospital stays.” Additionally, “reduced access to care may also increase deaths from treatable conditions.“

The Oct. 29 announcement of Rural Health Transformation funds by the Centers for Medicare and Medicaid Services indicates that the money “will support primary, maternal, specialty and behavioral health care access across rural California while growing the health care workforce and modernizing technology.”

“The Working Families Tax Cuts are already delivering for our communities,” Valadao stated in the announcement, “and this $233.6 million in Rural Health Transformation Program funding is a critical step toward improving California’s health care system.”

U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said in his statement that “every American deserves high-quality health care, no matter where they live.”

Kennedy, who in August visited Castle Family Health Centers in the Merced County community of Atwater to announce $102 million for health clinics nationwide, said this latest chunk of federal funds is “giving states the flexibility to build solutions around the people they serve while demanding accountability for results.”

While the Trump administration is portioning out the first year’s allocation of the five-year, $50 billion rural health program funds, the California Health Care Foundation reported that the administration has also frozen almost $3 billion destined for California for in-home supportive services. That money is used to pay for caregivers to provide personal-care assistance to senior citizens, people with disabilities, and children.

(Note: The California Health Care Foundation is a contributor to the Fresno State Institute for Media and Public Trust, which underwrites the Central Valley Journalism Collaborative’s Health Care Reporting Fellowship.)

Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.