Mon, Dec 8, 2025·Alameda County, California·Board of Supervisors

Alameda County Health Committee Meeting Summary (2025-12-08)

Discussion Breakdown

Affordable Housing34%
Homelessness34%
Healthcare Services28%
Procedural2%
Fiscal Sustainability1%
Workforce Development1%

Summary

Alameda County Health Committee Meeting (2025-12-08)

The Health Committee (Supervisors Miley and Tam) reviewed Measure A1’s 4th annual report and advanced it to the full Board, received an update on major federal HUD/Continuum of Care funding risks and local mitigation planning, and discussed paths to pursue state legislation to change Alameda Health System (AHS) governance—directing that the item be routed to the Public Awareness & Legislation (PAL) Committee for potential bill sponsorship.

Consent Calendar

  • None noted.

Public Comments & Testimony

  • David (SEIU 1021) (Item 4): Expressed that the AHS governance discussion is important to SEIU 1021 members; stated it could help address ongoing labor/personnel concerns; offered to share more information.

Discussion Items

  • Item 1: Measure A1 – Fourth Annual Report (July 2020–June 2022)

    • HCD staff presented the 4th Measure A1 annual report, noting Measure A1 passed with 73% voter approval and requires oversight and performance reporting.
    • Program results (during reporting period):
      • Rental program: 54 projects (15 pre-development, 14 under construction, 25 completed) totaling over 3,900 affordable rental units.
      • Leverage: Measure A1 generated $6 from other sources for every $1 of Measure A1 funding.
      • Doorway housing portal: Launch of the county’s single-application portal during the period.
      • Homeownership: 173 homeowners assisted; 800+ workshop attendees; 222 completed applications.
      • Project Homekey hotels: Two hotels acquired using state Homekey award with Measure A1 acquisition funds; used as shelters until construction began later.
    • Operational issues: Staff described reporting delays tied to oversight committee quorum rules (meetings canceled if quorum not met). Staff proposed bylaw changes to allow informational meetings without quorum.
    • Staffing constraints: COVID-era impacts included over a 50% vacancy rate in 2020–2022, slowing implementation; later staffing increased.
    • Supervisor Tam asked about:
      • Potential coordination/overlap among various oversight committees (Measure A1 vs. other measures); staff indicated A1’s structure includes city representation and meets quarterly, but quorum problems hindered action.
      • Details on Homekey matching requirements and whether the City of Oakland could operate the acquired hotels; staff stated the county had not discussed transfer to the City, had discussions with Oakland Housing Authority, and noted A1 funds are fully committed except program income expected to return to the Board in January.
      • Estimated ongoing operating costs for permanent supportive housing at the hotels; staff estimated $11,000–$14,000 per unit per year for operations (services separate) and noted Continuum of Care subsidies.
    • Supervisor Miley discussed:
      • Measure A1 exceeding original unit goals (staff stated goal was 3,800 units and the county surpassed it; later figures referenced ~4,400+ units).
      • Concerns about rising per-unit costs; staff distinguished cost per unit vs. county investment per unit and noted shelters and some alternative models may require higher local share due to limited leverage.
      • Local hire and contracting outcomes: report indicated local hire goal 30% and achieved 42% (hours); local business participation cited (e.g., 105 local businesses, $180M; small local businesses $79M).
      • Staff also stated a goal of 20% of units for people at 20% income or below and that the program achieved 29%, aided by vouchers.
      • Upcoming union utilization reporting: preliminary data suggested 80–85% of contractors were union shops.
    • Homekey hotels status: Staff reported both sites are under construction, converting rooms to permanent units, with expected completion around Aug–Oct (next year); services provided by contracted CBOs will continue as sites transition to PSH.
    • Doorway portal: Staff described functionality, transition to the regional BAHA/MT C platform for cost savings, and expected improved reporting (staff referenced having seen an earlier count of over 50,000 applications but did not provide updated confirmed totals).
  • Item 3: HUD Continuum of Care (CoC) NOFO – Federal Funding Risks and Local Response

    • Housing & Homelessness Services (H) presented implications of the FY25 CoC NOFO:
      • CoC funds represent about two-thirds of federal homelessness assistance locally: $60M of $90M annually.
      • Timeline described as unprecedented and accelerated (release Nov. 13, due Jan. 14) with potential renewal delays beyond May 2026, raising risk of funding gaps.
      • Major policy shift described: only 30% protected in Tier 1 (historically about 90%), and a cap of 30% toward permanent housing vs. local portfolio historically about 86% toward permanent housing.
      • Local portfolio impacts described: ~1,700 PSH units supported by CoC PSH grants (25 grants); other programs include RRH, TH/RRH, TH, SSO, coordinated entry, HMIS.
      • Staff stated: Tier 1 protection would be about $18M (30% of $60M), leaving $42M subject to competitive review.
      • Staff stated $33M in permanent housing would need to be reallocated or could be lost under the new parameters.
    • Local action plan: Formation of a NOFO response team (5-person cohort), strategy to preserve as much funding as possible, assess local backfill to avoid service/housing interruptions, and coordinate with at-risk grantees.
    • Supervisor Tam asked about required reallocation strategy and how to maintain as much of the $60M as possible; staff stated the county intends to apply for the full amount and redesign projects to fit new requirements while prioritizing retention of PSH.
    • Supervisor Miley emphasized that if federal actions require using Measure W for backfill (despite earlier intent to avoid funding existing services), staff should return to the Board for direction.
    • Staff clarified the apparent overlap between the $42M at risk and the $33M permanent housing exposure (not additive), explaining Tier 1 protection is tied to the 30% cap.
    • Update during meeting: Staff reported HUD withdrew the NOFO that day and was working on revisions, potentially increasing delays and heightening the potential need for bridge funding.
  • Item 4: Alameda Health System (AHS) Governance Options – Potential State Legislation

    • County Counsel summarized work originating in 2021 (subcommittee created by Supervisors Chan and Carson) evaluating governance reforms and producing two options:
      • Option A: Board of Supervisors could become AHS governing body, with a subsidiary board of trustees handling day-to-day operations.
      • Option B: Board of Supervisors becomes appointment authority for all trustees, with trustees as the governing body.
    • Counsel outlined draft legislative amendments to Health & Safety Code §101850 to enable Board flexibility, including:
      • Flexibility for the governing board to consist of Board members and/or county officers/employees (if specified in enabling ordinance).
      • Explicit language addressing conflicts/incompatible offices (referencing Govt Code sections including 1090, 1099, 1126, 87100).
      • Express delegation authority for day-to-day operations to subsidiary bodies while maintaining ultimate control.
      • Provisions regarding Alameda Healthcare District representation and requiring Board approval for future JPA affiliation agreements.
      • Authority for AHS to affiliate with/acquire hospitals/clinics (referencing lessons from the St. Rose situation) and to operate through corporations/joint ventures while maintaining private character of acquired private facilities.
    • County Admin/Legislative Affairs described a tight legislative timeline: bill requests to Legislative Counsel due Jan. 23; last day to introduce bills Feb. 20; need to identify a sponsor quickly and anticipate heavy workload due to state budget issues and federal impacts.
    • Supervisor Miley stated support for moving the effort forward; requested a clearer chronology for newer Board members and highlighted labor’s interest in governance changes.
    • Supervisor Tam supported pursuing flexibility and suggested building coalition support; agreed to route to PAL, noting PAL’s schedule constraints.
    • Committee discussion indicated the item should be brought to PAL for consideration as a sponsorship request, with potential Board action in January due to posting requirements.

Key Outcomes

  • Item 1 (Measure A1 4th Annual Report): Approved to forward to the full Board for adoption.
    • Vote: Miley Yes, Tam Yes (2–0).
  • Item 2: Pulled; deferred to early next year.
  • Item 3 (HUD/CoC NOFO): Informational update; staff to continue developing response strategy, track HUD revisions/withdrawal, and return with updates including potential bridge/backfill needs.
  • Item 4 (AHS governance legislation): Committee consensus to send to PAL Committee as a sponsorship/bill strategy item; staff to coordinate with Supervisor offices for PAL agenda placement and to prepare additional background/chronology for the Board.

Meeting Transcript

Progress. All right, so good morning, everyone. It's a bright Monday morning, December 8th, Health Committee. Take the role. Supervisor Town. Present. Supervisor Miley. Present. Right. We have a three items on today's agenda. Item number two has been pulled. I guess we'll take that up next year, first part of next year, item two has been pulled. We have items one, three, and four. So let's start with item one. Measure A1 fourth annual report. Thank you, supervisors. I appreciate the time on this committee's agenda. We are presenting today for your consideration and hopeful that you will be forwarding it to the full board for adoption, the fourth measure A1 annual report. This covers the period of July 2020 through June 2022. Next slide. As you know, and I'll just remind you that the Measure A1 passed with 73% of voter approval. It requires an oversight committee and regular performance reports. The fourth report covers this two-year progress period in our attempt to catch up on our annual reporting. I will also let you know that we do have a website that has full up-to-date data, including uh financials and project performance. Next slide. The report covers an executive summary. We continue to have our chapter called Bay Area Housing History, which looks at specific issues around housing in the Bay in Oakland and Alameda County. And then we look at the two main programs, the rental program and the homeownership program, we do a deeper dive into accomplishments in each of those program areas. And then the final chapter is generally the administration and financial expenditures to show what funds were spent and what staff accomplishments happened during that time period. Next slide. We wanted to just highlight that for the board to let you know that we took a look at everything that he did for the county as well as his commitment to housing and affordable housing and homeless issues. Next slide, please. During this reporting process, there were several delays, and I want to highlight that our current bylaws for the measure A1 oversight say that if a quorum is not met, the meeting must be canceled rather than turned into an informational meeting. And because of that, over the last two years, we've had a very difficult time having a full committee meeting. So we're gonna be proposing some bylaw changes to first this committee and then to the full board, actually, first to the oversight committee, then to this committee, and then to the full board that will allow us to meet even if we don't have a quorum. That way information can be passed on to the members that are present, and we can continue to post things on the website and get the meeting out to the public, the information out to the public. Next slide. So during this period, we had 54 rental projects. 15 were in pre-development, 14 were under construction, and 25 were completed. It was a total of over 3,900 affordable rental units. And you know, we continue to highlight that the Measure A1 program generates $6 for from other funding sources for every one dollar of Measure A1 funding. The other big thing that happened during this period was the launch of the doorway housing portal for Alameda County that allowed the single application period. So that was a single application site for all residents that were interested in applying. So that was exciting. Next slide. Under the two homeownership programs that we had up and running during this time period, we saw 173 homeowners assisted. And you can see here some of the work that we did. We had over 800 workshop attendees and 222 completed applications. Our process was to work with first-time homebuyer organizations across the Bay Area. Of course, we were looking for residents that lived or worked in Alameda County.