Tiffany Rowe is worried.
Food assistance and medical programs the North State’s most vulnerable residents rely on to survive are under threat by President Donald Trump’s "Big Beautiful Bill."
And this falls on Rowe’s desk.
She runs Butte County’s Department of Employment and Social Services, the agency that helps residents access food and health care assistance. Starting in 2026, changes to who qualifies for those programs — known in California as Medi-Cal and CalFresh — could put millions in the state at risk of losing coverage.
For the people running these programs, the uncertainty is already front of mind.
“What does this mean for the people we serve,” Rowe said. “What does it do for them, for their families, for their livelihood?”
Counties brace for higher costs and heavier workloads
Counties across the region are asking these same questions, and many don’t have clear answers. What is certain is that the changes will mean heavier workloads for county offices that administer these services, along with higher out-of-pocket costs to keep programs running. At the same time, the state is moving ahead with its own eligibility changes in the new year, forcing counties to scramble to prepare and avoid a disruption in services.
“Do we have enough staff? Can we afford to hire staff? Will we receive any additional funding for these additional workloads?” Rowe questioned.
It's a major concern in the North State, where nearly half of residents in California’s 1st Congressional District depend on subsidized health care, and hunger rates are higher than in most of the state.
Rowe said the bill’s downstream effects could be serious for many residents.
“It's a very uncertain time to sit in and space to be in, and the potential impacts to our community, both for our clients and our staff, are pretty heavy."- Tiffany Rowe, Butte County Department of Employment and Social Services director
“It's a very uncertain time to sit in and space to be in, and the potential impacts to our community, both for our clients and our staff, are pretty heavy,” she said.
Under the president’s agenda, people enrolled in these programs would face new work requirements and more frequent eligibility renewals. That means more paperwork for counties, along with higher costs to keep services operating. In Butte County alone, those changes would add at least $1.3 million a year in new expenses, Rowe said.
Earlier this year, President Donald Trump signed H.R. 1, known as the “One Big Beautiful Bill Act,” into law. The sweeping measure cuts nearly $1 trillion from Medicaid, the joint federal and state program that helps cover medical costs for low-income Americans. It also cuts billions from the Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps.
The bill came up for discussion at a Butte County Board of Supervisors meeting earlier this month, where supervisors questioned whether they'll be on the hook to fill funding gaps when the cuts take effect. Board Chair Tod Kimmelshue, who represents District 4, expects the money would have to come out of the county’s general fund.
“We will have to find that money to continue these programs. We have no choice ..."- Tod Kimmelshue, Butte County District 4 supervisor and chair
“We will have to find that money to continue these programs. We have no choice, I take it, in the matter, right?” Kimmelshue said.
District 3 Supervisor Tami Ritter agreed saying she thinks the county has little room to maneuver.
“I think we should go with, we do not have a choice,” Ritter said. “These are the poorest people in our county and this is how they eat.”
She described the situation like “watching a car crash in slow motion.”
Ritter said she’s especially concerned about seniors in the county.
“We know that there's going to be cuts to home and community based services,” she said. “So as we see those services decline, our already at risk senior population is going to be faced with even bigger challenges.”
Caught between state and federal changes
In nearby Shasta County, where budgets are already tight, the county’s Health and Human Services Agency (HHSA) has put a hiring freeze in place to prepare for what’s ahead.
“The hiring freeze is allowing us to maintain current staffing and build up the reserves we need for the additional costs we’re going to see,” said Holly Weld, a program manager at the county’s HHSA.
Weld emphasized that the changes aren’t just coming from Washington. Earlier this year, Gov. Gavin Newsom signed a state budget that freezes Medi-Cal enrollment for undocumented immigrants over the age of 19 starting in 2026. State officials say the move is expected to save more than $5 billion, as California grapples with its own budget troubles.
As of now, much remains unknown about how the cuts will affect the North State. Weld and Rowe said their departments are still waiting for guidance from higher-level agencies.
“Until the federal government provides comprehensive guidance on all of the changes coming out of H.R. 1, the state is kind of in limbo for providing guidance, and then it trickles down to the county for prepping for these changes,” Weld said.
Until then, county officials say all they can do is prepare as best they can.
