San Diego supervisors cut red tape as federal cuts loom

San Diego County supervisors voted 4-1 on Tuesday to reform how the county administers health coverage for low-income residents.

The vote comes as federal changes threaten to leave tens of thousands of local patients without insurance.

Board Chair Terra Lawson-Remer and Vice Chair Monica Montgomery Steppe introduced the reforms to modernize County Medical Services. The package removes several administrative hurdles that currently block access to care. These barriers include mandatory property liens, credit checks, and reimbursement agreements.

The reforms also reduce the number of in-person appointments required during the application process. According to a statement from the supervisors, these changes aim to make it easier for people to get help when they have nowhere else to turn. Montgomery Steppe noted that current requirements make getting care unnecessarily difficult. She called the new rules an important step toward making health care more accessible.

Federal projections cited by the board indicate that 68,761 San Diegans will lose Medi-Cal coverage due to new work requirements. Another 67,630 people currently receiving full-scope Medi-Cal are projected to lose that status because of immigration eligibility changes. Lawson-Remer warned that the county must prepare for severe federal funding cuts and rising costs. She stated that people do not stop getting sick when they lose their health coverage. The consequences of these federal holes in the safety net will eventually appear in local clinics, hospitals, and emergency rooms.

Supervisor Jim Desmond was the only board member to vote against the measure. He agreed with many of the updates to the application process but disagreed with the overall direction of the program. Desmond argued that the county should not expand medical services to able-bodied adults who do not work at least 20 hours a week or to those living in the United States without documentation. He said the county cannot afford to do that.

The board had previously voted 4-1 in March to study these specific reforms. That earlier vote led to the formation of an ad hoc subcommittee composed of Lawson-Remer and Montgomery Steppe. One major component of the new rules eliminates the requirement for applicants to sign property liens. These liens allowed the county to secure repayment of medical expenses against real property. The new plan releases existing liens and ends lien-based repayment for services.