San Diego County supervisors weigh $20.425 million pilot to bridge Medi-Cal coverage gaps

The San Diego County Board of Supervisors on Oct. 27 is scheduled to consider a 12-month Safety Net Bridge pilot program that would spend up to $20.425 million to keep residents connected to care if they lose Medi-Cal or CalFresh benefits under the federal law known as H.R. 1.

County staff estimate that 68,761 of the 309,939 San Diego County Medi-Cal recipients subject to new work and community engagement requirements will be at risk of losing coverage, according to the board letter signed by Chief Administrative Officer Ebony N. Shelton. The county does not currently provide primary care, the letter says.

The largest piece, $12.4 million, would go to primary care providers that serve Medi-Cal patients, such as community health centers, to offer short-term primary care, same-day no-cost prescription medications and links to social services. Care would be available for up to 90 days per patient, with a possible 90-day extension, in person, by telehealth or at mobile medical units.

The plan also includes $6,600,000 for Medi-Cal and CalFresh education and enrollment help, mostly through contracts with community-based organizations using community health workers, $750,000 to expand community health fairs and $675,000 for county administration. The pilot would serve residents ages 19 to 64 who meet Medi-Cal eligibility rules but may temporarily lose coverage.

Services would be available countywide, with resources focused on the communities most affected by the Medi-Cal changes, the letter says. Most of the money would come from one-time use of the county’s unlocked reserves set aside for safety net services, about $17.6 million, plus $2.15 million in one-time Medi-Cal administrative revenue.

The pilot builds on the board’s Nov. 4, 2025, direction to explore a Safety Net Bridge program and its June 25, 2026, approval of emergency food distribution events with two food banks. If approved, staff would report back with a mid-point progress report and return within 12 months with data on whether to continue the pilot.

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