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California's Fresno County opens record $5.5 billion budget hearings as $241 million care tab looms

Some of the clearest signs of strain are showing up in the Public Health Department.

The words "CITY HALL" are displayed on the exterior of a building.

Photo Credit: iStock

Fresno County budget hearings for fiscal year 2026-27 are set to begin next week, with officials weighing a proposed record $5.5 billion plan against growing uncertainty around state and federal support.

Among the most unpredictable pieces is indigent care, with the county estimating that its obligation could fall anywhere between $41 million and $241.1 million.

Here's what to know

Eight department heads are expected to present their plans when Fresno County supervisors begin budget hearings September 14. The proposed 2026-27 budget, according to Fresnoland, would support more than 8,300 employees and services for over 1 million residents.

Even with the total coming in about $150 million above the previously adopted budget, roughly a 3% increase, county officials say that larger number shouldn't be taken as a sign of especially strong finances.

Fresno County Administrative Officer Paul Nerland wrote in the budget message that the county is continuing "to navigate a challenging and increasingly uncertain fiscal and operating environment."

A major source of concern is the prospect of lower state and federal funding for major programs, including health care and food assistance. The county has set aside $10 million for what it expects will be a new local funding match under H.R. 1 for indigent care, and those costs are projected to rise.

The county is also directing $13 million in reserve funding to the Department of Social Services, which the proposed budget says may be used "based on increases in caseloads for the Foster Care and General Relief programs."

More background

Some of the clearest signs of strain are showing up in the Public Health Department, which is expected to see about a $10 million drop, roughly 7%, and will lose 16 vacant positions. Other departments slated for reductions include Social Services, Probation, Agriculture, and the County Administrative Office.

At the same time, several departments are in line for increases. The Sheriff's Office is set to receive roughly $13.6 million more, or about 4%, along with six additional full-time jobs, including two coroner positions and a crime scene specialist. Behavioral Health is expected to gain $37 million, though the proposed budget says part of that increase is tied to estimated Medi-Cal reimbursement changes.

The county is also relying on one-time money to keep the budget balanced and is not contributing to its $90 million general reserve fund this cycle, according to Fresnoland.

Pressure is also evident in the District Attorney's Office, where staffing remains an issue. The proposed budget states, "Law school enrollments are down nationwide, and many civil firms, State agencies and other counties who pay higher wages and offer better benefits/lifestyle are recruiting the Department's lawyers."

What can be done?

According to Fresnoland, the hearings are scheduled for 9:30 a.m. on September 14 in the board chambers on the Hall of Records' third floor. Residents can also participate virtually through Zoom.

Voters also have another decision on the horizon: Measure A, which would ask voters to approve a transient occupancy tax on hotel and short-term lodging stays that county officials say could raise about $4.5 million annually.

Where can I learn more?

Fresno County's budget debate comes as governments across California grapple with similar funding pressures. The articles below examine state spending cuts, county planning decisions, or other major funding fights affecting residents.

• California lawmakers are weighing cuts to climate programs as the state confronts deficit pressures.

• Santa Barbara County moved ahead with a major climate action plan affecting residents and businesses.

• California's insurance commissioner sought billions for the FAIR Plan after catastrophic wildfire losses mounted.

• The California Legislature approved a $10 billion bond to fund resilience and environmental projects.

• California officials took unprecedented action on insurance as wildfires drove coverage and affordability concerns.

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