San Diego County Supervisors Vote to Overhaul Safety Net Health Program

Reforms aim to expand eligibility and access to County Medical Services program

Published on Mar. 4, 2026

Got story updates? Submit your updates here. ›

The San Diego County Board of Supervisors voted 4-1 to move forward on overhauling the County Medical Services (CMS) program, which serves residents who can't afford insurance and don't qualify for Medi-Cal. The reforms will adjust eligibility standards, eliminate lien requirements, expand application options, review covered services and cost-sharing, and modernize the program.

Why it matters

The supervisors said the changes are in response to looming federal cuts to Medicaid that are projected to cause hundreds of thousands of low-income San Diegans to lose Medi-Cal coverage, leading to increased reliance on emergency rooms and uncompensated care costs for local hospitals. The CMS program is described as the most restrictive of its kind among large California counties.

The details

The board voted to form an ad-hoc subcommittee of Supervisors Terra Lawson-Remer and Monica Montgomery Steppe to work with community members on developing the CMS reforms. The reforms will be presented to the full board within 60 days after the fiscal year 2026-27 budget is adopted. Supervisor Jim Desmond voted against the measure, citing a lack of going through the staff process, while Supervisor Joel Anderson suggested the subcommittee should seek more public feedback.

  • The San Diego County Board of Supervisors voted on Tuesday, March 3, 2026 to move forward on overhauling the CMS program.
  • The CMS reforms will be presented to the full board within 60 days after the fiscal year 2026-27 budget is adopted.

The players

San Diego County Board of Supervisors

The governing body of San Diego County that voted 4-1 to overhaul the County Medical Services program.

Terra Lawson-Remer

San Diego County Supervisor who, along with Supervisor Monica Montgomery Steppe, will lead an ad-hoc subcommittee to develop reforms to the CMS program.

Monica Montgomery Steppe

San Diego County Supervisor who, along with Supervisor Terra Lawson-Remer, will lead an ad-hoc subcommittee to develop reforms to the CMS program.

Jim Desmond

San Diego County Supervisor who voted against the measure to overhaul the CMS program, citing a lack of going through the staff process.

Joel Anderson

San Diego County Supervisor who suggested the ad-hoc subcommittee should seek more public feedback and ensure residents in unincorporated areas are part of the reform process.

Got photos? Submit your photos here. ›

What they’re saying

“Hundreds of thousands of low-income San Diegans are projected to lose Medi-Cal coverage as a result, leading to increased reliance on emergency rooms and millions of dollars in additional uncompensated care costs for local hospitals.”

— Terra Lawson-Remer and Monica Montgomery Steppe, San Diego County Supervisors (timesofsandiego.com)

“The antiquated CMS system is not a badge of pride. At a time when more residents are losing coverage, we cannot afford outdated rules and unnecessary barriers.”

— Monica Montgomery Steppe, San Diego County Supervisor (timesofsandiego.com)

“I'm not against what you're doing. I just want to make sure that when we're working with these vulnerable populations, that we're really thoughtful and we get it right the first time.”

— Joel Anderson, San Diego County Supervisor (timesofsandiego.com)

What’s next

The ad-hoc subcommittee composed of Supervisors Lawson-Remer and Montgomery Steppe will work with community members to develop the CMS reforms, which will be presented to the full Board of Supervisors within 60 days after the fiscal year 2026-27 budget is adopted.

The takeaway

The overhaul of San Diego's County Medical Services program aims to expand eligibility and access to this critical safety net health coverage as the county braces for an expected surge in uninsured residents due to looming federal Medicaid cuts. The reforms seek to modernize an outdated system and remove unnecessary barriers to care for vulnerable populations.