To: Board of Supervisors of Sonoma County
Department or Agency Name(s): County Executive
Staff Name and Phone Number: Christina Rivera (707)565-4592
Vote Requirement: Informational Only
Supervisorial District(s): Countywide
Title:
Title
Overview of County Medical Services Provider (CMSP) Services
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Recommended Action:
Recommended action
Receive overview of County Medical Services Program (CMSP) and anticipated impacts resulting from federal administration policy changes.
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Executive Summary:
The County Medical Services Program (CMSP) provides time-limited health coverage for uninsured, low-income adults in 35 rural and semi-rural California counties, including Sonoma County, and assists these counties in meeting their indigent care responsibilities under California law. Representatives from CMSP will provide an overview of the program and how federal policy changes are anticipated to impact program participation, coverage, and eligibility.
Discussion:
Originally established in 1983, the County Medical Services Program (CMSP) provides health coverage for uninsured low-income adults, ages 21-64, in 35 rural and semi-rural California counties, including Sonoma County, and assists these counties in meeting their indigent care responsibilities under California law (WIC Section 17000).
The WIC Section 17000 enactment in 1937:
• Established each county’s duty to relieve and support the indigent poor and serves as the legal foundation for county indigent care obligations as the “provider of last resort.”
• Limits county responsibility to those “legally resident therein”, which does not include undocumented persons.
• While counties have broad discretion in setting standards, they must provide “medically necessary care” that is “sufficient to remedy substantial pain and infection”.
CMSP participation supports counties in meeting their Section 17000 obligations but does not relieve them of these responsibilities. Instead, CMSP provides a pooled risk health benefit program, with a goal of reducing costs associated with meeting the responsibilities.
The CMSP Governing Board, established in 1995 and composed of ten county officials and one ex-officio State representative, sets program eligibility requirements, determines the scope of covered healthcare benefits, and sets provider reimbursement rates for both CMSP benefit programs - CMSP and Connect to Care.
CMSP was largely funded through counties’ 1991 Realignment until the full implementation of the Affordable Care Act (ACA) in 2014. With its enhanced access to Medi-Cal and subsidized medical coverage, the ACA’s implementation greatly reduced CMSP membership and Realignment payments were similarly reduced. In 2019, the portion of 1991 Realignment funding that supported CMSP was completely redirected to the state. The Governor's January FY 2026-27 Budget Proposal did not include a proposal to reallocate Realignment, or any other source of funding, back to counties to support anticipated increased need for indigent care.
With the changes to Medi-Cal eligibility required by H.R. 1 and lapse of ACA coverage subsidies, CMSP projects that up to 11,560 Sonoma County residents could qualify for indigent care services through the County.
Ninety-seven (97) Sonoma County Residents are currently enrolled in CMSP, down from approximately 6,000 before the implementation of the Affordable Care Act. Since 2014, CMSP has waived the County’s $718,947 administrative fees.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
October 14, 2025 - The Board of Supervisors received reports from County Departments and community-based organizations on the anticipated impacts from the H.R.1 federal funding bill.
Fiscal Summary
Narrative Explanation of Fiscal Impacts:
N/A
Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - CMPS Presentation
Related Items “On File” with the Clerk of the Board:
None