by Michele Mashburn on the All Things Disability Equity web site, June 4, 2026
Two weeks ago, more than 100 people lay down in a parking lot in East Oakland. Above them stood cardboard gravestones: “Died unhoused.” “No suicide hotline.” “Rural hospital closed.” “Can’t afford insurance.” Hospital and ER staff, Medi-Cal and Medicare recipients, and community members staged the die-in outside Eastmont Town Center to protest the federal cuts to healthcare funding under H.R. 1. The demonstrators created 100 tombstones, each one representing $100 billion in federal healthcare funding cuts. (See this Oaklandside article for more details.)
This Friday, June 5, Santa Clara County is doing the same thing. Renova Park, Santa Clara Valley Medical Center Campus, 11:30am. ATDE is part of the coalition bringing this action to San José, alongside Human Agenda, Defensoras, Santa Clara County Single Payer Health Care Coalition, Working Partnerships USA, Valley Physicians Group, Fund Healthcare Not Billionaires, Latinas Contra Cancer, the Long Term Services and Supports for All Grassroots Coalition, CSO San Jose, and Patient Organizing Comité. Our Founder Michele Mashburn will be speaking.
These cuts equate to people dying and an action like this doesn’t let people look away.
More than 460,000 Santa Clara County residents are currently enrolled in Medi-Cal. Work requirements, six-month redeterminations, asset limits, and monthly premiums are all set to hit at once, through a combination of H.R. 1 and Governor Newsom’s proposed state budget. As Bob Brownstein of Working Partnerships USA put it: “The work requirements were not put in place to encourage people to work. The work requirements were put in place so that people would be thrown off of Medicaid. The budgeting is done based on the assumption that the work requirements are going to reduce the cost. If everybody met the requirements, there’d be no savings.” (See the San José Spotlight.) The reported savings is people losing coverage and the care they depend on to survive.
These are not budget savings, but rather, costs transferred directly onto counties, providers, and the people who can least afford to bear them. Nationally, six months after H.R. 1 was signed into law, 115 hospitals and clinics have closed or reduced services across 32 states, and 6,440 healthcare workers have been laid off. (See the February 2026 report from Senate Finance Committee Ranking Member Ron Wyden and House Energy and Commerce Ranking Member Frank Pallone.)
In Santa Clara County, VMC is already facing a projected $1 billion deficit, and Medicaid represents approximately $1.9 billion in county revenue, with roughly 70% of the county’s public healthcare system funded by Medicare and Medicaid combined. Rather than helping the county withstand that pressure, Newsom’s May Revision adds an additional $231 million in losses to public hospitals this fiscal year, increasing to $322 million the following year. County Executive James Williams called it a massive leadership failure. (See the San José Spotlight.)
Governor Newsom’s proposed state budget would immediately end a person’s IHSS benefit when their Medi-Cal is discontinued, eliminating the Residual Program that previously allowed benefits to continue temporarily while Medi-Cal status was resolved, a $68 million cut in 2026-27 alone. The budget also proposes reinstating a Medi-Cal asset limit of $2,000 for a single person and $3,000 for a couple for disabled adults and seniors, cutting around 62,000 people off Medi-Cal in the first two years, and eliminating the IHSS Backup Provider System, which provides temporary coverage when a primary provider is unavailable. The budget also shifts IHSS costs to counties when hours exceed a set average, and counties are not prepared to absorb that: poorer counties and people who cannot navigate the already complicated system will be hurt, institutionalized, or die due to lack of care. (See Disability Rights California’s summary of the May Revision and the LTSS4All Coalition letter.)
Disability advocates spent years fighting to get the asset limit removed. Newsom just proposed putting it back. The framing of these cuts as cost containment ignores the most basic math: a skilled nursing facility costs the state $137,000 per person per year, more than four times the $30,000 annual cost of IHSS. Cutting home care does not save money. It shifts costs onto the people who can least afford to absorb them, and onto the institutions, like VMC, that cannot turn anyone away.
Mental health services are taking the same hit. Santa Clara County’s TRUST program, which sends trained staff instead of police to mental health calls, is at serious risk. The May Revision proposes making mobile crisis response an optional Medi-Cal benefit, which would cut reimbursements for TRUST at the same time a separate funding source for the program expires in November. County officials estimate the May Revision could reduce Medi-Cal funding to cover only 25% of TRUST’s annual budget, down from 36% today. This is a program that has consistently shown higher utilization than crisis response alternatives that involve police. The community built it. The budget is dismantling it.
On immigrant access, what is happening is already documented. More than 86,000 immigrants without legal status left or were denied Medi-Cal in January and February alone, exiting the program at a rate six times higher than other enrollees. Part of what is driving that is fear: the Trump administration began sharing Medicaid data with ICE, including names, addresses, and citizenship status of Medi-Cal members, creating a significant chilling effect on enrollment. The enrollment freeze compounds this. Undocumented adults who lapse on paperwork or payments for more than 90 days lose coverage permanently and cannot re-enroll. About 1.3 million immigrants in California are expected to lose their full-scope Medi-Cal over the next four years due to the freeze and other state changes. Starting July 2026, dental benefits are eliminated for adults without satisfactory immigration status. Starting July 2027, $50 monthly premiums kick in, and policy analysts at the California Legislative Analyst’s Office said most of the expected $300 million in annual savings will likely come from increased disenrollments, not from revenue collected. (See KVPR/Public Health Watch.)
The federal context is more hostile, with additional impacts still pending. The CMS deferral of $1.1 billion in federal IHSS funding to California, issued under the premise of a fraud investigation, is doing exactly what it was designed to do: reactivate the narrative that these programs are wrong, that the people who use them don’t have value, that cutting them is the responsible thing to do. California explained exactly why IHSS grew: more people served, wages increased to address a provider shortage, higher acuity needs. CMS approved all of it. The facts were never in dispute. None of that matters when the goal was never really about fraud.
IHSS is not a supplement. For hundreds of thousands of disabled people in California, it is the difference between living in your home and being institutionalized. The cuts being made now will not be fully felt today. They will be felt next year and the year after, in lost hours, lost providers, higher institutionalization, higher hospitalization, more need for care, and for some people, in their deaths. This is the predictable, documented consequence of dismantling in-home support.
The people most directly affected by these cuts are also the ones being asked to fight them, in spaces not built for them, over and over, in a system designed to wear them down. Showing up costs more when the world was not built for you. People retreat, not by choice but by design. The system wins either way: if you show up, it extracts from you; if you can’t, it continues unobserved. That is structural ableism operating exactly as intended, and it is part of why an action like Friday’s die-in matters, because it makes visible what the system counts on keeping invisible.
The coalition is calling on Speaker Rivas and legislative leaders to act on three demands as state budget negotiations continue:
- $500 million for public hospitals
- An emergency healthcare benefit for people losing Medi-Cal
- Funding for county enrollment and outreach to keep people connected to care
ATDE adds two more:
- Protect IHSS by reversing the elimination of the Residual Program and Backup Provider System, rejecting the county cost shift, and abandoning the proposed asset limit reinstatement
- Restore Medi-Cal access for immigrants by reversing the enrollment freeze, premium requirements, and dental benefit cuts
The Oakland die-in was a mirror. The gravestones named what we know to be true and rarely say plainly: these are not budget line items. These are people. Some of them will not survive what is coming if we don’t change course.
That’s why ATDE is going to be at VMC this Friday. We’ll have signs available for people who need them. If you’re in Santa Clara County and you can be there, we want you there. Friday, June 5, 11:30am at Renova Park, Santa Clara Valley Medical Center Campus, 751 S. Bascom Ave, San José.