The governor’s May Revision is being framed as a response to fiscal uncertainty, but for Californians, it reads as a decision to make essential services harder to reach, just as need is rising. When we talk about budget reductions, the focus is often on what disappears, but in practice, costs rarely vanish. They are transferred elsewhere: onto unpaid family caregivers, hospitals, or local systems already under strain.
Beyond the line-items, there is a lived budget experienced in daily life — as people try to age with dignity, care for family, and remain connected to their communities. Budgets do more than allocate dollars. They reveal priorities and signal what and whom we value enough to protect when resources tighten.
Viewed through this lens, this Revise conveys several troubling assumptions:
- That staying home is optional – access to home- and community-based services (HCBS) through Medi-Cal is low priority, rather than essential to helping Californians remain safely in their homes and communities
- That community-based organizations (CBOs) can continue to absorb increasing demand with fewer resources
- That demographic growth requires no durable public investment
HCBS are not “nice-to-have” services. They’re needed infrastructure that keep people in their homes and communities. During a recent Assembly hearing on proposed reductions to the In-Home Supportive Services (IHSS) program, one advocate described the program plainly: “It’s a basic survival need.”
Reductions to Medi-Cal will impact access to HCBS and are harmful to older adults and people with disabilities. They are fiscally counterproductive and inconsistent with California’s commitment to building a “California for all.”
The Hidden Stakes of the May Revise
The May Revise includes no new investments for older adults and people with disabilities, while reducing access to Medi-Cal, which will decrease access to HCBS. The most glaring of reductions is the reinstatement of the Medi-Cal asset test at $2,000 for individuals/$3,000 for couples. Over 60,000 Medi-Cal enrollees are anticipated to lose coverage due to this reduction.
California’s older adult population is projected to grow by nearly 60 percent in less than fifteen years—and when nearly one million Californians are expected to require help with self-care— so this budgetary approach is especially concerning.
The implications will have system-wide effects, including:
- Delayed care that leads to higher acuity and increased costs
- Greater risk of unnecessary institutionalization
- Increased strain on family caregivers
- And mounting pressure on local governments and CBOs already stretched to capacity
California is retreating from HCBS at the very moment federal instability threatens access. H.R. 1 (2025-26) reduces funding for Medi-Cal, the primary payer of HCBS. Additionally, the Centers for Medicare and Medicaid have issued a letter to the state, warning they will withhold $1.3 billion in Medi-Cal funds, most of which are earmarked for the IHSS program. Together, these impacts will disproportionately harm low-income older adults, people with disabilities, and family caregivers.
The evidence is already clear: restricting access to HCBS does not save money. These proposals are short-sighted, and they undermine years of progress under the Master Plan for Aging and the state’s commitment to rebalancing Medi-Cal spending toward HCBS.
A State Defined by What It Chooses to Fund
California faces a budget crisis, and lawmakers are being asked to make difficult choices. Nevertheless, these choices will carry long-term human and fiscal costs.
State leadership should be focused on long-term sustainability, especially as federal funding grows more uncertain.
This requires more than managing deficits each year. As the gubernatorial race takes shape, candidates are increasingly pressed to articulate how they would make California more affordable, particularly with respect to HCBS. This moment calls for strong leadership willing to explore new revenue solutions to address the state’s structural deficit and rising cost-of-living challenges.
This current period may be remembered as a turning point; not because of one decision, but because of a series of incremental choices that accumulated into lasting consequences.
The true cost will not be measured on paper, but in Californians’ lives. California still has an opportunity to reaffirm a simple but consequential principle: a “California for All” includes people as they age, and that dignity, stability, and community are worth protecting, even in difficult fiscal moments.
Sarita A. Mohanty, MD, MPH, MBA serves the President and CEO of The SCAN Foundation, which envisions a society where all of us can age well and with purpose. Learn more about the mission of TSF.
Assemblymember Dr. Corey Jackson represents Assembly District 60, serving the county of Riverside.