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# "This Is Scary" — Federal Changes Hit Health Care in Mendocino County (Typos fixed)
- URL: https://www.mendolocal.news/this-is-scary-federal-changes-hit-health-care-in-mendocino-county-typos-fixed/
- Published: 2026-09-16T19:53:07.000Z
- Updated: 2026-09-16T20:53:26.000Z
- Description: The changes that Congress wrote into the federal budget are scheduled to reshape Medi-Cal in 2027. But when Mendocino County's three acute care hospitals looked at their emergency rooms this year, the shift had already begun.
- Author: Elise Cox
- Tags: Fort Bragg, News

*Clarification: Mendocino County has three acute-care hospitals, including one on the coast. The fall in Medi-Cal participation in Mendocino County in the last year is steeper than the drop in participation in the Partnership HeathPlan that manages Medi-Cal for 24 northern California counties. September 16, 2026 1:06 p.m.*

FORT BRAGG, Calif. — The changes that Congress wrote into the federal budget law known as HR 1 are scheduled to reshape Medi-Cal in 2027\. But when Mendocino County's three acute care hospitals looked at their emergency rooms this year, the shift had already begun.

"We're seeing actually a couple percentage points move from Medi-Cal or partnership to uninsured, and that's already starting in January of this year," Richard Riter, chief financial officer for Adventist Health North Coast Network, told the Mendocino County Board of Supervisors on Sept. 15\. "We've been talking about all these changes are going to be happening next year. We're actually seeing them start this year."

"This is scary," Riter said. 

Riter spoke at the county's third health summit — a roughly three-hour session, running from about 1:45 to 5 p.m., in which Partnership HealthPlan, the County Medical Services Program, Social Services, the Consolidated Tribal Health Project, Mendonoma Health Alliance, Coast Life Support District, and a state association walked the board through what the federal law will cost the county's patients and providers. No formal vote was taken.

Much of the impact flows through Partnership HealthPlan, the public plan that manages Medi-Cal for the county. Regional director Vicki Klakken said Partnership's membership has already dropped about 5.5% since December, falling in Mendocino County from roughly 40,800 to 38,109 in the past year. Beginning Jan. 1, 2027, she said, another 84,000 members statewide — including roughly 3,614 Mendocino residents classified as having "unsatisfactory immigration status" — will be moved out of managed care and into fee-for-service Medi-Cal, losing benefits such as rides to appointments and CalAIM care navigation.

That term, "unsatisfactory immigration status," is broader than it sounds. In Medi-Cal it is a funding category — whether a person's immigration status lets the state draw federal dollars for full-scope coverage — and it can include some green-card holders, people with DACA, and people whose status simply hasn't been verified, not only undocumented residents.

"This means these individuals will no longer qualify for transportation to their providers, among other services," Klakken said.

A separate change will require some adults in the Medi-Cal expansion group to prove they work, volunteer, or attend school about 80 hours a month. That group is the population of low-income adults who became eligible for Medi-Cal under the Affordable Care Act's Medicaid expansion, which California adopted on Jan. 1, 2014 — adults 19 to 64 who qualify on income alone, generally up to 138% of the federal poverty level, rather than because they fit a traditional category like children, pregnant people, seniors, or people with disabilities. Before the ACA, a low-income adult without children usually could not get Medi-Cal at all; the expansion opened it to them. Klakken referred to the group as "those in Obamacare."

Roughly 11,000 adults fall into that group in Mendocino County and up to 3,000 residents could lose coverage if they cannot document the hours, according to the County Medical Services Program. Next year also brings six-month eligibility renewals for the affected population, and cuts the window for retroactive coverage from three months to one or two.

"Our fear is these individuals will not get regular care and they will end up walking into the hospital with some very serious illnesses or simply because they don't have the regular care," Klakken said. "And that's our biggest fear. And the hospitals are likely going to be picking up the slack on that."

For Mendonoma Health Alliance, which runs a mobile clinic along a 60-mile stretch of the south coast, the math is stark. Executive director Micheline White Kirby described her organization as "kind of a unicorn" — the first in the state to offer mobile primary care without a brick-and-mortar clinic — but said that model leaves it exposed. "We were not offered a traditional contract with partnership. We have a fee-for-service contract and we are only getting reimbursed at 20% to 25% of our fee schedule," she said. "That means we're going to be writing off anywhere from 75% to 80% of our expenses."

"Thank God for philanthropy because it's the only thing in our community keeping this mobile clinic alive," White Kirby said.

White Kirby also questioned whether the work requirements can function in her service area at all. "We have almost no childcare in our region," she said. Of the 75 to 85 residents who receive services from community health workers and peer recovery workers, many are single mothers or stay-at-home mothers. "When we require them to work 80 hours or even volunteer, what we're really doing is requiring them to find childcare to pay for," she said. "And in addition to that, they're going to be now making income that changes their eligibility for Medi-Cal so we are going to be pushing them out of the program that keeps their family healthy."

The strain reaches the ambulances, too. "We talked last year about ambulance service also picking it up," Supervisor John Haschak said. "Because people wait until the very last minute and then they have to take the ambulance to the ER and all, you know, just the whole effect on the system of healthcare."

Bronwyn Golly, EMS chief with the Coast Life Support District, said her two crews run some of the longest transports in California — "five to seven hours from start to finish" round trip. Fee-for-service Medi-Cal, she said, pays a flat $118 per transport "whether you are in downtown Ukiah or if you're transporting from Gualala to Santa Rosa." A public-provider supplement currently lifts that to about $1,100, but Golly said it is "on the HR 1 chopping block." A second subsidy worth about $300,000 of the district's budget is set to sunset in 2029\. The district has a benefit-assessment measure, Measure D, on the November ballot.

The county's backstop is the County Medical Services Program, which covers indigent residents who fall off Medi-Cal. Executive director Kari Brownstein said CMSP holds a roughly $312 million reserve but no new revenue stream, and estimated 1,000 to 3,500 additional Mendocino residents could land on the program. To stretch the reserve, the CMSP board is proposing to roll eligibility back toward its pre-2014 form — lowering the income ceiling, reinstating asset limits, and trimming benefits including vision, audiology, and elective dental. A state association representative, Sarah Dukett of the Rural County Representatives of California, estimated the reserve would last one to two years.

Dukett's central message was that the county's best leverage is documentation. "Building a case is going to take all of us," she said, "tracking our local costs, our caseload changes, coverage losses, what our uncompensated care looks like, and sharing that data and local experiences directly with legislative members." As for whether counties are behind, she said everyone is "trying to figure out building the plane as they fly it," and that Mendocino, as a CMSP county, is better positioned than counties "that have no program, no infrastructure, no staff, and no money."

County Social Services put the scale in context. The department reported that Mendocino's Medi-Cal caseload has more than doubled since before the Affordable Care Act expansion — from about 8,400 households to more than 20,000\. Riter, for his part, pointed to the one thing the providers agreed on: "We actually are all aligned. We all have the same incentives. We all have the same concerns." That county-wide alignment, he said, "is a bit of an anomaly."