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Medi-Cal, our state’s Medicaid program, is the cornerstone of California’s health care system. Funded with both state and federal dollars, Medi-Cal provides health care services to more than 13 million low-income Californians who live in all 58 counties. Of the 10 counties with the highest shares of residents enrolled in Medi-Cal, six are in the San Joaquin Valley: Tulare (54.8%), Merced (50.9%), Fresno (49.9%), Kern (45.9%), Stanislaus (45.1%), and Madera (45.1%). However, millions of Californians — including children, older adults, and people with disabilities — would be at risk of losing Medi-Cal coverage or benefits if the US Senate agrees to the deep cuts that were recently approved by House Republicans (H.R. 1628) with President Trump’s support. These cuts include 1) phasing out the Medicaid expansion, through which California has extended coverage to nearly 4 million nonelderly adults, and 2) shifting massive — and unaffordable — costs to states by capping federal Medicaid funding. In California, this cost-shift would amount to nearly $6 billion in 2020, rising to an annual shift of $24.3 billion by 2027, according to a Department of Health Care Services analysis.