Contra Costa Health faces a projected $730 million cumulative deficit through fiscal year 2030-31. Federal and state funding cuts could leave up to 93,000 county residents without health coverage by 2031.
Contra Costa Health Director Grant Colfax and other officials presented the shortfall to the Board of Supervisors on Tuesday, Aug. 25, at the county seat in Martinez. Local News Matters first reported on the presentation.
For the current fiscal year, Contra Costa Health (CCH) trimmed an original $80 million budget gap down to $10 million through productivity improvements and cost containment, according to Contra Costa News. But the long-term picture is far worse.
What's driving the shortfall
Two policy shifts account for most of the damage: H.R. 1, the federal "One Big Beautiful Bill," and state changes to Medi-Cal eligibility and reimbursement rates. Together, they reduce enrollment, cut reimbursement, and slash supplemental funding that public hospitals depend on.
CCH estimates roughly 47,500 residents will lose managed Medi-Cal eligibility beginning Jan. 1, 2027, and by 2031, as many as 93,000 could be uninsured, per Contra Costa News.
Why it matters in Lamorinda
CCH runs 11 community health clinics countywide, the Contra Costa Regional Medical Center (CCRMC), and the county's only Psychiatric Emergency Services program. One in five county residents receives primary care at county clinics, and in fiscal year 2025-26, CCRMC and the health centers logged more than 38,000 emergency visits, according to Contra Costa News.
Lamorinda residents who rely on the county health plan, behavioral health services, or emergency psychiatric care at CCRMC could see those services scaled back or restructured.
Four scenarios on the table
CCH is evaluating four paths forward for the medical center, per Contra Costa News:
- Maintain current operations
- Shift to a single-specialty behavioral health model
- Pursue multi-specialty growth
- Wind down CCRMC as an acute care facility and reinvest in the health centers network
The department's recommended direction is multi-specialty growth, which would expand high-demand services and modernize operations.
Board already on notice
The fiscal crisis is not new. In December 2025, CCH projected more than $300 million in cumulative state and federal funding reductions through 2029 and briefed the Board. At a Dec. 16, 2025, Board presentation on the same funding crisis, then-Board Chair Candace Andersen, who represents District II including Orinda, said: "These changes mean fewer people covered and fewer dollars coming into the system at the same time."
The Board directed CCH in December to return with a plan to strengthen supports for residents ineligible for Medi-Cal. Tuesday's presentation updated the deficit projection from $300 million to $730 million as federal policy details solidified.
No vote was taken Tuesday. The staff report and presentation are available on the county's Legistar system.
