San Joaquin Valley residents who rely on Medicaid – either for their own vital healthcare or to take care of loved ones – are facing their “worst case scenario” as they prepare for $1 trillion in cuts to the program now that President Trump has signed the so-called “One Big Beautiful Bill.”
With narrow passage along party lines, the Republican-backed law is estimated to result in some 3.4 million Californians losing coverage, according to numbers from state health officials. Those losses will likely be acutely felt in the Valley, where across the eight-county swath from San Joaquin to Kern more than 51% of the population relies on Medicaid, called Medi-Cal in state, for their health insurance.
That includes 32-year-old Hughson resident Mohamed Rashid, who was born with spina bifida and uses a wheelchair. He relies on Medi-Cal for his medical care as well as his In-Home Supportive Services (IHSS), an optional Medicaid service which states, including California, use to pay caregivers to help disabled residents attend to daily needs in their homes.
Rashid, who is paralyzed from the waist down, said without his in-home care he would have difficulty with everyday tasks like showering and preparing food. His parents, who provide his care, receive payment through IHSS.
“This is the worst case scenario, in my opinion,” said Rashid, who became interested in disability rights advocacy while still a student at Hughson High. “(My family) is worried that (my care) is going to get worse. … I feel uncertain about the future of the services.”
The cuts to the federal health insurance program for low-income Americans and new requirements have staggered implementation dates, with many not starting until after the 2026 midterm elections. The changes were made to offset the impact of making tax cuts passed in the first Trump administration that largely go to corporations and some of the wealthiest Americans permanent.
The new law has several Medicaid provisions that will trim costs, add new eligibility requirements, impose new fees and more over 10 years. They include:
- Imposing 80-hour work requirements per month for all applicants ages 19 to 64 (with exemptions for the “medically frail” and parents of children age 13 and under).
- Requiring a $35 fee per visit for covered adults for many services in most states, including California, where Medicaid coverage was expanded under the Affordable Care Act.
- Requiring Medicaid eligibility to be renewed every six months for those in the program’s expansion population, instead of the current 12-month cycle.
- Limiting states’ ability to collect provider taxes, which are used to increase Medicaid payments to hospitals, clinics and other providers.
- Barring Medicaid payments for non-abortion services to Planned Parenthood and any other nonprofits that received a certain amount of federal funding and primarily provide family planning or reproductive services.
- Ending Medicaid eligibility for some lawful immigrants – including refugees, people who have been granted asylum and abused spouses and children – who were eligible under current law.
Impact on rural hospitals and clinics
In addition to the cuts, the projected impacts of the new federal policy on rural clinics are also raising concerns among medical providers and healthcare professionals across the region. Medical centers such as Golden Valley Health Centers and Community Medical Centers, dotted across Stanislaus, San Joaquin and Merced counties, receive federal funding and provide services to a majority of the region’s Medi-Cal patients. Observers say cuts to services, or even the closure of clinics, could affect anyone who depends on them, even those with private insurance.
“I think that the healthcare cuts specifically are going to harm rural clinics and hospitals that are already struggling to stay open financially,” said Adriana Ramos-Yamamoto, senior policy analyst at the nonpartisan research group the California Budget & Policy Center.
“That means that people in those communities no longer have access to timely and comprehensive health care services,” she added. … “They may have to wait even longer to see a primary care physician or a specialist to treat their health care condition. They might have to travel longer distances, or they may have to skip or delay their care altogether, which is so harmful for their health outcomes.”
The loss of services is of great concern to Valley Mountain Regional Center Executive Director Leinani Walter. The center serves people with developmental disabilities across Stanislaus, San Joaquin, Amador, Calaveras and Tuolumne Counties. About 40% of the center’s budget for diagnostics, evaluations, case management and more comes from federal Medicaid funding, Walter said.
“It’s really heartbreaking, I’ll be honest with you,” Walter said. “I mean, we were doing our best to get by, to serve the high number of people we have to serve every single day. But to anticipate cuts to our most vulnerable – people with disabilities, our foster youth, our children with special needs. I just, I don’t know what else to say, really. It feels very much like it’s a blow to humanity.”
Both of California’s Democratic senators, Alex Padilla and Adam Schiff, voted against the bill. House members representing the San Joaquin Valley split exactly along party lines with Republicans Tom McClintock of El Dorado Hills, David Valadao of Hanford and Vince Fong of Bakersfield voting for the bill and Democrats Adam Gray of Merced, Josh Harder of Tracy and Jim Costa of Fresno voting against it.
For Modesto resident Astrid Zuniga the impact of those votes will be felt both personally and professionally. She has served for the past year as the president of the United Domestic Workers, a union that represents more than 220,000 home care and family child care providers in the state. That includes some 8,000 workers in Stanislaus County, many of whom provide in-home supportive care paid for by Medicaid.
Those workers are now concerned about being able to continue in their positions and provide care.
“We have been hearing from members who are just scared,” Zuniga said.”They’re like, what’s going to happen to my loved one, or what’s going to happen if I lose this income? Because many of us quit our full-time jobs to provide care for a loved one, right? And as it is, it’s not the best paying job. Generally, most of my workers are right around minimum wage with little to no benefits. So this is their livelihood.”
She feels the same fear as the mother of a 26-year-old disabled son for whom she provides in-home care and relies on Medicaid for all his healthcare services. She said the uncertainty of which services will be cut and which programs will be impacted makes it hard for families to plan for the future care of their loved ones.
She worries that the more frequent and more stringent eligibility and work requirements could lead to the loss – even if only temporarily – of her son’s coverage.
“The scenarios play out in your head, right?” she said. “If he loses, say, his seizure medications because of all this paperwork that’s got to be filled out. If it isn’t done in a timely manner, or for whatever reason, and then he’s without seizure meds. That’s a life or death situation.”
Rashid also worries about the unknowns and the future of his care. He wonders if he’ll have to seek help outside of his Hughson home, which he said would change his quality of life “tremendously.” He also thinks some voters have misconceptions about people on Medicaid, including that they just sit home and collect checks. In fact, the program provides payments for medical services directly to providers, and no money is ever given to recipients.
“Just because someone is on Medicaid, it doesn’t mean they are lazy,” he said. “It just means they need extra help.”
Marijke Rowland is the Editor of The Modesto Focus, a project of the Central Valley Journalism Collaborative. She was previously the senior health equity reporter for The Intersection, a health equity reporting lab advanced by CVJC.
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