The electric sector simultaneously faces two challenges: decarbonization to mitigate, and adaptation to manage, the impacts of climate change. In many regions, these challenges are compounded by an interdependence of electricity and water systems, with water needed for hydropower generation and electricity for water provision. Here, we couple detailed water and electricity system models to evaluate how the Western Interconnection grid can both adapt to climate change and develop carbon-free generation by 2050, while accounting for interactions and climate vulnerabilities of the water sector. We find that by 2050, due to climate change, annual regional electricity use could grow by up to 2% from cooling and water-related electricity demand, while total annual hydropower generation could decrease by up to 23%. To adapt, we show that the region may need to build up to 139 GW of additional generating capacity between 2030 and 2050, equivalent to nearly thrice California’s peak demand, and could incur up to $150 billion (+7%) in extra costs.