SAN DIEGO (CNS) - Responding to looming federal cuts to Medicare, the San Diego County Board of Supervisors voted 4-1 Tuesday to move forward on overhauling a program that serves residents who can't afford insurance and don't qualify for Medi-Cal.
Supervisors Terra Lawson-Remer and Monica Montgomery Steppe are requesting an evaluation of County Medical Services, described as a "program of last resort for eligible adults, which covers only necessary medical services."
An ad-hoc subcommittee composed of Lawson-Remer and Montgomery Steppe will work with community members to develop reforms to CMS, including:
- adjusting eligibility standards that are considered restrictive, such as age limits and income thresholds
- eliminating lien requirements and reforming property limits
- expanding phone and virtual application options
- reviewing covered services
- reviewing the impact of cost-sharing requirements on patient access
- analyzing costs to modernize the program
The supervisors said the reforms will be presented to the board within 60 days after the fiscal year 2026-27 budget is adopted.
The supervisors described San Diego's CMS program as "the most restrictive program of its kind among large counties in California."
However, Supervisor Jim Desmond, who voted no, told City News Service he did so "because it didn't go through the staff process." Desmond also said ad-hoc subcommittees lack transparency.
Last August, the supervisors voted 3-2 -- with Joel Anderson and Desmond opposed -- to form the subcommittee focused on safety net and behavioral health systems. Lawson-Remer and Montgomery Steppe said U.S. House Resolution 1, passed by Congress last year, will reduce Medicaid funding nationwide, tighten eligibility rules and add more requirements starting Jan. 1, 2027.
"Hundreds of thousands of low-income San Diegans are projected to lose Medi-Cal coverage as a result, leading to increased reliance on emergency rooms and millions of dollars in additional uncompensated care costs for local hospitals," the supervisors said.
Vice Chair Montgomery Steppe said the "antiquated CMS system is not a badge of pride. At a time when more residents are losing coverage, we cannot afford outdated rules and unnecessary barriers," she added.
Before Tuesday's vote, board Chair Lawson-Remer said it was important "to make a plan so we're not blindsided."
Anderson, suggested that the subcommittee should meet in the main chamber, seek public feedback and list its actions on the county website. He also said that he wasn't assured that 550,000 residents in the unincorporated area were part of the reform process, especially if they don't have easy access to a health clinic.
"I'm not against what you're doing," he told Lawson-Remer and Montgomery Steppe. "I just want to make sure that when we're working with these vulnerable populations, that we're really thoughtful and we get it right the first time."
Several hospital system officials and community activists endorsed the reforms of CMS during Tuesday's public comment period.
Lindsey Wade, senior vice president of the Hospital Association of San Diego and Imperial Counties, said the measure is ultimately about protecting patients, especially as emergency rooms experience a higher volume of patients.
San Diego County doesn't operate its own hospitals, but contracts with community clinics, hospitals and physicians.
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