PROJECT OVERVIEW
How H.R. 1 will decrease the number of Alameda County residents with health insurance
Highlights
With its passage in July 2025, H.R. 1, or the One Big Beautiful Bill Act (OBBA), created new requirements for Medicaid beneficiaries. Among these requirements were the addition of new work requirements, as well as the requirement to verify one’s income at least every six months starting on January 1, 2027. In addition, OBBA limits Medicaid eligibility for qualified noncitizens.
In California, county human services agencies determine their constituents’ eligibility for Medicaid (known as Medi-Cal in California) and are therefore responsible for integrating work requirements into their eligibility determinations.
The Better Government Lab is working with Alameda County to project how many Alameda County residents will lose their Medicaid coverage as a result of the new work requirements, evaluate how these changes affect the costs of care overall and costs borne by Alameda County, and provide evidence-based insights to inform County decision-making and policy discussions.
Overview
The Better Government Lab has developed a micro-simulation model based on county Medi-Cal enrollment data to make initial projections of how many Alameda County residents will lose Medi-Cal coverage by the end of 2027. The initial projections show that 18% of Medi-Cal enrollees in Alameda County will lose their coverage by December 2026 and that another 17% of Medi-Cal enrollees in the County will lose their coverage by December 2027. This represents a coverage loss of about 150,000 people.
Going forward, BGL will report how many Alameda County residents in different subpopulations will lose their health coverage as a result of the new Medi-Cal requirements and estimate changes to healthcare costs as well.
Timeline
September 2025 - Current
In Progress
Programs
Medicaid
Topics
Work Requirements, Administrative Burden