REGIONAL — With votes on the 2026 St. Louis County budget looming, county officials say they’re still working to refine estimates of the cost of the federal reconciliation bill signed into law by President Donald Trump on July 4. One thing, however, is for certain: The biggest hit to county coffers is likely to fall on county social services.
That was the message county commissioners heard on Tuesday from county administrators, who are tasked with determining the fiscal impact of the so-called One Big Beautiful Bill.
Changes to the Medicaid program, known as Medical Assistance in St. Louis County, will likely prompt the biggest change to the county’s workload, potentially adding $6.4 million or more to the county’s costs for managing the program. That’s according to Linnea Mirsch, deputy county administrator, who said the number is based on a 2018 estimate by Minnesota Management and Budget on the fiscal impact to the county from a similar work reporting requirement that was discussed but never implemented during the first Trump administration. Mirsch acknowledges, however, that the estimate is not refined.
The higher costs are expected to come primarily from the county’s increased workload, as social service staff will need to implement the work reporting requirement as well as comply with other changes, including the requirement that MA recipients document their qualification for the program twice a year, rather than annually as has long been the case in Minnesota.
That requirement alone doubles the associated workload for county staff, notes Dusty Letica, director of economic services and supports for the county.
County officials estimate that about 9,400 county residents will need to meet the work reporting requirement to remain in the MA program. That excludes the many seniors, disabled individuals, and adults with children under age 13 on the MA rolls, who won’t be required to document their work. What kind of documentation would qualify isn’t clear at this point, but county officials are hoping the process can be streamlined to reduce the time involved for both county staff and those seeking MA coverage.
According to national data, released Monday from the Department of Human Services, about two-thirds of those on Medical Assistance already work, while the remainder are either in school, retired, working in home as a caregiver, or are ill or disabled.
Those who are working will soon need to regularly document their work, while those who aren’t will soon need to show why they qualify for an exemption from the reporting requirement.
Processing all that documentation will be time-consuming for all involved, and taxpayers will be on the hook for the costs incurred by county staff since the counties administer MA in Minnesota.
“That’s significant because all the verifications take time,” said Letica.
If there’s a bit of good news, it’s that most of the budgetary impact for the county won’t be felt until the 2027 budget, according to Letica.
“It’s really rolling out over the next two years,” said Letica.

SNAP cuts represent cost shift to county
While the Medicaid changes will likely have the largest fiscal impact on the county, the GOP-passed reconciliation measure also cuts federal reimbursement for the administration of the Supplement Nutrition Assistance Program, or SNAP, from 50 percent to 25 percent, creating an estimated $1.5 million annual shortfall for St. Louis County starting Oct. 1, 2026.
The county currently serves about 16,000 SNAP recipients monthly.
The legislation particularly impacts Minnesota and nine other states that follow a “state-supervised, county-administered” model for SNAP, meaning cost shifts go directly to local governments rather than state agencies.
St. Louis County serves as the gatekeeper for these programs for its residents, determining eligibility and managing enrollment for roughly 20 percent of county residents who receive government assistance.
A potentially far more significant change will take effect in 2027, when states, or counties in the case of Minnesota, will be required to share a portion of the cost of the SNAP benefits paid to recipients. That cost-share will be based on the state’s error rate, which is currently nine percent in Minnesota. At that rate, St. Louis County would face an additional cost of about $3 million. If states can reduce their error rates to six percent, the cost-share requirement goes away.