Pharmacist, Pittsburg Medi-Cal
East County · Oct 14
“Three people this week found out at my counter that their Medi-Cal was gone. None of them had seen a letter. One walked out without his insulin.”
Feeds: Pharmacy counter discoveriesVerified
Contra Costa Early Warning
⚠ Prototype — indicator values are sample data
A community-owned early warning system for HR 1. It watches for warning signs — overdue renewals, paperwork losses, people giving up — so we can act before people lose CalFresh and Medi-Cal they still qualify for.
Data window: Sept 2026 · Refreshed monthly
— Why early warning
Official counts tell us who already lost coverage. Early warning tells us while we can still act.
Most coverage loss under HR 1 will come from paperwork, not ineligibility. In Arkansas, more than 95% of people subject to work requirements already met them or should have been exempt. Each indicator below has thresholds set by the community, and it raises its level before losses show up in official counts.
ClearWithin normal range. Keep watching.
WatchDrifting. Work group checks the cause.
WarningAct now. Brief the Steering Committee.
UrgentPeople are losing help. All hands.
— Countdown
—days
until Medi-Cal work requirements and six-month renewals begin on January 1, 2027
Jun 2026CalFresh work rules expanded to adults up to 64
Oct 2026Refugees and asylees lose full-scope Medi-Cal
Jan 2027Medi-Cal work requirements begin
Jan 2027Medi-Cal renewals every six months
Indicators
Eight readings, each with a threshold the community set. The marker shows where this month falls.
Indicator values are illustrative until data-sharing agreements are in place. Thresholds are proposals for the Steering Committee to adopt.
Community Signals
⚠ Sample signals — demo data
Neighbors, nurses, pantry volunteers, barbers and caseworkers report what they see. Their stories are the first warning, often months before system data moves.
What are you seeing with CalFresh or Medi-Cal right now?
Converging patterns
Warning
No letter, no warning
People learn they lost coverage at the pharmacy or clinic, not by mail. Points to bad addresses.
Warning
“CalFresh is ending” rumor
Self-cancellations reported at pantries in West and East County.
Watch
Veterans caught off guard
Former exemption removed. Veterans not reached by outreach yet.
Urgent
Refugee families going silent
Fear after the 10-day status rule. Families avoiding every official contact.
Where people get stuck
Never got the letter
62%
Couldn't prove hours
48%
Phone line dropped
41%
Didn't know exemption
37%
Afraid to ask
29%
Share of sample signals naming each barrier. A signal can name more than one.
Coverage Watch
⚠ Sample data
System data from the county and health plans, shown as aggregate counts only. The question every chart answers: did people lose help because they didn't qualify, or because of paperwork?
Automatic renewal rate
Share of Medi-Cal renewals completed from data the county already has, with no form. The community threshold is 65%.
Automatic renewal rateWarning threshold (65%)
Sample data. Source when live: EHSD monthly renewal report.
Why people lost Medi-Cal
Monthly discontinuances split by reason. Paperwork losses can be prevented; most ineligible losses cannot.
Paperwork / no responseFound ineligible
Sample data. Source when live: CalSAWS discontinuance reason codes via EHSD.
Back on within 90 days
People cut off for paperwork can be restored if they return their packet within 90 days. A high rate here means the loss was preventable.
Medi-Cal — Sept
34%
CalFresh — Sept
27%
Sample data.
Equity Lens
⚠ Sample data
The same readings, broken out by region, race and ethnicity, language and age, so we can see who is being hit first. Darker cells mean more warning signs.
| Overdue renewals | Paperwork share of losses | Back on in 90 days | Signals this month | |
|---|---|---|---|---|
| Region | ||||
| East County | 1,840 | 74% | 29% | 96 |
| West County | 1,420 | 69% | 36% | 71 |
| Central County | 940 | 63% | 41% | 38 |
| Race and ethnicity | ||||
| Latino | 1,560 | 74% | 29% | 72 |
| Black | 820 | 77% | 26% | 58 |
| White | 980 | 63% | 40% | 41 |
| Asian and Pacific Islander | 560 | 70% | 33% | 22 |
| Multiracial or another group | 280 | 68% | 35% | 12 |
| Language | ||||
| English | 2,310 | 64% | 39% | 118 |
| Spanish | 1,350 | 76% | 28% | 61 |
| Other languages | 540 | 79% | 22% | 26 |
| Age | ||||
| 19–34 | 1,610 | 72% | 33% | 54 |
| 35–54 | 1,580 | 66% | 36% | 87 |
| 55–64 | 1,010 | 70% | 30% | 64 |
“Back on in 90 days”: a lower number is worse, so it is shaded by how far it falls below the county average. Groups under 11 people are never shown. Race and ethnicity come from county records as people report them, shown only as totals.
In this sample, East County, Black and Latino residents, and families who speak languages other than English or Spanish show the most warning signs. Both point to Move 2 (trusted messengers in their own language) and Move 7 (address checks).
Protect what this lens can see. A proposed federal rule would stop the census from collecting race and ethnicity data. Public comments are due November 2, 2026.
Mitigation Tracker
⚠ Status is illustrative
When an indicator reaches Warning, these are the responses. Each move is tied to the readings it should bring down.
Response tracker
1
The Ghost Renewal
Raise automatic renewals with data the county already has · Lowers: automatic renewal rate
2
Trusted messengers
Train pastors, barbers, teachers, pantry volunteers · Lowers: self-cancellations
3
Side by side
Hands-on help filling out forms · Lowers: paperwork losses
4
Count the invisible hours
Approved volunteer sites beyond Concord and Fairfield · Lowers: CalFresh time-limit losses
5
The pharmacy counter
Cards and QR codes where people find out · Lowers: pharmacy discoveries
6
The early warning
County–health plan data sharing for renewal reminders · Lowers: overdue renewals
7
The address check
Ask at every pantry, clinic and library · Lowers: returned mail
8
Test the message
Two text versions, keep the one that works · Lowers: overdue renewals
9
The same-day relay
Hand-off to legal help within the 10-day window · Lowers: relay requests unmet
10
Lived experience leads
Paid peer navigators and seats at the strategy table
Renewal Days
Every mitigation in one place: groceries, haircuts with a coverage check, renewals on the spot, address updates and peer navigators.
AN
Antioch · [Park, date TBD]
Proposed first site. East County shows the most warning signs.
RI
Richmond · [Site, date TBD]
West County follow-up.
How it works
Civic Signals is community-maintained and community-owned. It joins two streams, what people report and what the systems count, and turns them into early warnings and a public dashboard.
1 · Gather
Signals come in
- Signal form in English and Spanish
- Text message and QR codes at pantries, clinics, barbershops
- 211 referral follow-ups
- Monthly county and health plan counts
2 · Check
Community researchers
- Paid researchers with lived experience review every signal
- Remove names and details that identify anyone
- AI helps group signals; people confirm each pattern
3 · Detect
Readings vs. thresholds
- Eight indicators, refreshed monthly
- Thresholds set and changed by the Steering Committee
- Levels: clear, watch, warning, urgent
4 · Act
Alerts and the dashboard
- Warning and urgent alerts to work group leads by email and text
- Public dashboard on civicsignals.net
- Monthly one-page brief for BRIDGE
Data the dashboard needs
Aggregate counts only. No one's case file ever enters Civic Signals.
| Source | What it feeds | How often | Status |
|---|---|---|---|
| Community signal form | Signals, barriers, self-cancellations, relay requests | Continuous | Live |
| EHSD renewal and discontinuance reports | Automatic renewal rate, overdue renewals, reasons for loss, back on in 90 days | Monthly | Needs data-sharing agreement |
| Medi-Cal health plans (CCHP and others) | Renewal reminders through clinics and doctors' offices | Monthly | Needs agreement (state template MEDIL 23-17) |
| Food Bank of Contra Costa and Solano | Volunteer-hour sites, pantry visits, self-cancellation reports | Monthly | In conversation |
| Hospitals and clinics | Uninsured ER visits, application processing days | Quarterly | Proposed |
| 211 Bay Area | Referral outcomes and dead-end numbers | Monthly | Proposed |
Rules that protect people
- Counts, not cases. Only totals leave partner systems.
- Small groups stay hidden. Any cell under 11 people is suppressed.
- No immigration status is ever collected.
- Quotes are shared only with consent, and with identifying details removed.
- The community owns the data. Partners sign a data agreement; the Steering Committee approves every new source.
Technology
Start simple and cheap; grow only when the pilot proves it.
Pilot (now)
Static site on GitHub Pages · signal form · monthly counts in a shared spreadsheet · thresholds in one editable file
Static site on GitHub Pages · signal form · monthly counts in a shared spreadsheet · thresholds in one editable file
Next
Open-source database · secure upload for partner counts · automatic email and text alerts · Spanish and more languages
Open-source database · secure upload for partner counts · automatic email and text alerts · Spanish and more languages