San Diego Supervisors Seek Overhaul of Little-Used County Medical Program

Supervisors vote to explore expanding eligibility and promoting the County Medical Services program, which currently serves just 2 people at a time.

Mar. 3, 2026 at 10:33pm

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San Diego County supervisors are moving forward with potential changes to the County Medical Services program, which provides health care subsidies for low-income residents deemed 'medically indigent'. The program currently has very restrictive eligibility criteria, including requiring participants to have a lien on their home and be U.S. citizens - criteria that are more restrictive than other large California counties. Supervisors voted to direct staff to explore expanding eligibility and promoting the program more in the community, after a consultant found the program is 'not a badge of pride' in its current state.

Why it matters

The County Medical Services program is an important safety net for low-income residents who don't qualify for other programs like Medi-Cal. However, its restrictive eligibility criteria have resulted in extremely low enrollment, with just 39 people enrolled over the most recent fiscal year and only about 2 people typically enrolled at any given time. Expanding the program could provide critical health coverage for more vulnerable residents.

The details

Supervisors voted to direct county staff to explore changes to the County Medical Services program, including updating the eligibility criteria and promoting the program more in the community. Currently, the program requires participants to have a lien put on their home and be U.S. citizens - criteria that are more restrictive than other large California counties. County staff will have to bring back recommended updates to the program two months after the county's 2026-2027 budget is adopted. The program has seen declining enrollment since the Affordable Care Act was implemented, with a peak of 40,000 enrollees in 2013 dropping to just 39 total enrollees over the most recent fiscal year.

  • The County Medical Services program peaked at 40,000 enrollees in 2013 when the Affordable Care Act first opened enrollment.
  • In the county's most recent fiscal year, a cumulative total of only 39 people were ever enrolled in County Medical Services for any length of time.
  • About two people are typically enrolled in the County Medical Services program at any given time, according to county data.

The players

Monica Montgomery Steppe

A San Diego County Supervisor who said the 'antiquated CMS system is not a badge of pride' and that the county is 'rebuilding a system that is equitable, accessible and responsive'.

Jim Desmond

A San Diego County Supervisor who cast the lone vote against the item, saying he wanted more feedback from staff about potential changes.

Tim McClain

A spokesperson for the San Diego County Health and Human Services Agency, which administers the County Medical Services program.

Jacey Cooper

The former state Medicaid director who was hired by San Diego County as a consultant to advise on possible changes to county medical programs.

SEIU 221

The largest labor union for San Diego County workers, which is leading a citizen-led ballot initiative to raise a sales tax surcharge that would provide $4 million in funding for the County Medical Services program.

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What they’re saying

“Our antiquated CMS system is not a badge of pride. Today's action ensures we are rebuilding a system that is equitable, accessible and responsive.”

— Monica Montgomery Steppe, San Diego County Supervisor

“I wanted more feedback from staff about potential changes.”

— Jim Desmond, San Diego County Supervisor

What’s next

County staff will have to bring back recommended updates to the County Medical Services program two months after the county's 2026-2027 budget is adopted in the summer.

The takeaway

The overhaul of the County Medical Services program could provide critical health coverage for more low-income residents in San Diego County, but will require addressing the program's restrictive eligibility criteria and improving community awareness and enrollment.