The Santa Barbara County Public Health Department paused its plan to make layoffs and transition thousands of patients away from county clinics due to “unsatisfactory immigration status.” The decision follows an ongoing injunction to a change in federal law.
Mouhanad Hammami, the director of Public Health, presented this update to the county Board of Supervisors at the Nov. 18 meeting. Supervisors voted 5-0 not to act on the layoffs.
In October, Public Health presented its plan to tackle budget issues, which included a round of layoffs. Supervisors asked Public Health staff to conduct more community outreach and talk with local Service Employees International Unions about how to prevent laying off 55.2 full time equivalent positions in the department.
During public comment on Nov. 18, Jay Forest, a Public Health employee, recognized the efforts to hold off on reducing positions.
“When staff is cut, prevention is cut, which is a much-needed safeguard in our community,” Forest said. “Reducing staff undermines these efforts directly by leaving our most vulnerable community members without protection. This would not only be a public health failure, but a moral failure.”
At the Oct. 7 meeting, supervisors also discussed the patient transfers. As federally qualified health care centers, county clinics would lose funding if they continued to see the approximately 7,000 patients with what Medi-Cal deems unsatisfactory immigration status. The department planned to work with CenCal Health to transfer patients to other providers by January.
With that plan now paused, Public Health doesn’t anticipate a loss in revenue from losing patients while the injunction holds.
“We understand that there might be some changes happening in February in the legal matter,” Hammami said. “I know that the federal government has filed for an appeal, and I think there is an accelerated schedule for a decision to be made in February.”
Following the supervisors’ direction since the October meeting, Hammami presented to the community with CenCal Health and spoke with clinicians who work directly with the impacted patients.
The director added that more than 50 community members attended a Spanish-language outreach event with representatives from Mixteco Indigena Community Organizing Project (MICOP) and other organizations in North County.
“We also heard a lot of the feedback and the fears that our community members had,” Hammami said. “These meetings are not stopping. … We pledged to continue this dialogue because what we are experiencing is not going to end today or next week.”
Though no layoffs or patient transfers are currently planned, Public Health is still facing a deficit for the 2026-27 fiscal year. Hammami attributed the shortfall to increased costs for services, supplies, and salaries, plus state and federal changes to Medi-Cal.
Public Health estimates a structural deficit of $7.6 million in the next fiscal year, Hammami said.
On top of that, state changes could create a $6.6 million shortfall. Starting in January, certain adults with unsatisfactory immigration status won’t be eligible for Medi-Cal, and in July, California will reduce the reimbursement rate for clinics serving those patients, Hammami explained.
Federal policies due to H.R. 1, known as the Big Beautiful Bill, could cause an additional $3.2 million loss in revenue.
All in all, Public Health may see a deficit of $17.4 million in the next fiscal year, according to Hammami. It’s anticipated that the department will have $6.1 million in its fund balance in June, the end of the 2025-26 fiscal year.
“This is what we are faced with,” Hammami said. “This is what we will come back to you with [at] budget workshops and budget discussions, and it will require some major changes.”
The shortfall could cause Public Health to stop offering unrequired services like endocrinology, neurology, and urology. Public Health only offers those specialty care services at the Santa Barbara clinic, Hammami said.
“If we need to accommodate some shortfalls in our next year’s budget, then the specialty services are going to be probably the first we are going to evaluate,” Hammami said.
If the injunction is lifted in the future and patient transfer is necessary, 31 providers were identified that can see patients with unsatisfactory immigrant status, Hammami said.
This article appears in Nov 27 – Dec 4, 2025.