Thousands might lose Medi-Cal come 2027. Voters will decide if there’s more money to help.

On Jan. 1, new rules for Medicaid come into effect that have prompted fear that tens of thousands of low-income San Diego County residents might lose health care coverage as a result.

To lessen the impact, county supervisors are reforming a rarely-used medical care program and spending $20 million to give people health care on a short-term basis.

The Board of Supervisors signed off on the efforts Tuesday as it continues to ready the region’s social safety net for stricter rules on who is eligible for Medicaid, administered as Medi-Cal in California.

At the start of the New Year, certain Medi-Cal recipients will have to show they’re working or performing community service for at least 80 hours a month in order to receive benefits. Many Medi-Cal recipients will also have to renew their eligibility twice a year instead of annually starting on Jan. 1.

Taken together, the new work requirements and extra paperwork have county officials estimating that nearly 69,000 people might lose health care coverage by the end of the decade.