Alameda County Board of Supervisors Joint Social Service and Health Committee Special Meeting - January 12, 2026
Alameda County Board of Supervisors Joint Social Service and Health Committee Special Meeting - January 12, 2026
This special joint meeting of the Alameda County Board of Supervisors' Social Service and Health Committee focused on the impacts of federal HR1 and state budget proposals on county health and social services. The meeting featured three informational presentations: a backbone agencies update, a state budget overview, and detailed analysis of policy changes affecting Medi-Cal for non-citizens. No formal votes were taken; the session was informational and planning-oriented.
Public Comments & Testimony
- Andy Martinez-Patterson (CEO, Alameda Health Consortium/Community Health Center Network) thanked the board for commitment to the safety net, emphasized the need for unified system coordination, and noted that FQHCs face $188 million in cuts. He supported the backbone coordination efforts.
- Casey (Alameda Health System employee) asked about the impact of Prop 63 (MHSA) within the context of the budget and its use at John George.
- Tony Panetta (Chief Impact Officer, Alameda Health Consortium) expressed disappointment that the state budget kept cuts to clinic enhanced payment rates for immigrants remaining in Medi-Cal and noted that asylum seekers, refugees, and victims of human trafficking would be treated as unsatisfactory immigration status holders effective October 2026, limiting them to restricted Medi-Cal.
- Kathy Rodriguez (resident near Llewellyn Explosion in Hayward) raised off-topic safety concerns about a commercial property and county ordinance violations.
Discussion Items
1. Backbone Agencies Update (Anika Chowder, Interim Director, AC Health; Andrea Ford, Director, SSA)
- Presented the coordination structure among AC Health, SSA, key health partners (Alameda Alliance, Alameda Health System, Clinic Consortium), and community providers (CPAG).
- Highlighted policy tracking, advocacy (opposing public charge changes, PFAS rollback, gender-affirming care restrictions), and weekly federal policy updates.
- Reported on outreach for UIS (unsatisfactory immigration status) population: supported over 1,500 people, resulting in 418 referrals to enrollment assistance specialists. Used texting campaigns, postcards (88,000 sent by Alliance, 5% response rate), and promotoras.
- Discussed Measure W funding ($2.5 million) for Medicaid outreach: a year-long public information campaign and enhanced outreach through CBO partners.
- Supervisor Miley asked about evaluation of UIS outreach; staff noted no baseline N but considered 418 new enrollments positive. Supervisor Tam asked about work requirements planning; staff noted CalFresh ABOD implementation in June 2026 (presentation next month) and Medi-Cal work requirements guidance expected June/July 2026.
- Supervisor Fortunato Bass expressed concern about meeting proliferation and urged minimizing meetings to allow staff to focus on work.
2. Governor's January Budget Proposal (Amy Costa, Full Moon Strategies; Hannah Hamilton, SSA; Jessica Blakemore, AC Health)
- Amy Costa presented state budget overview: total budget $348.9 billion, general fund $248.3 billion. Revenues $42.3 billion above projections, but driven by volatile AI stocks. Operational deficit of $20.9 billion. Governor proposed $23 billion in reserves. MCO tax extension assumption critical; if denied, creates significant hole. State estimates $1.4 billion increased cost from HR1 in budget year, mostly Medi-Cal and CalFresh, with no backfill for county administrative costs.
- Hannah Hamilton detailed social services impacts: CalFresh administrative cost increase of $382 million (state/county share shift to 25/75); SSA share estimated $8.8 million, total $24.9 million. No line item for benefit payment cost sharing (potential $2 billion if state error rate >10%). IHSS: $233.6 million cost shift to counties starting FY27-28; Alameda County gets 8% admin increase but $5 million net county cost increase for CFCO. CalWorks: single allocation increase of $2.6 million for Alameda County. Realignment funds only 2% increase, below COLA. Federal funding freeze on TANF (CalWorks) temporarily blocked by federal judge; 23,300 individuals enrolled in CalWorks in Alameda County.
- Jessica Blakemore covered health/homelessness impacts: Budget maintains Medi-Cal eligibility changes for UIS; reduces rates for UAS Medical patients at FQHCs effective July 1, 2026. No additional resources for indigent programs. MCO tax long-term revenue limited. Behavioral health: Prop 1 shifts, $4 billion to counties, but prevention funding reduced. Mobile crisis benefit: enhanced federal funding ends 2026; state proposes optional benefit shifting non-federal share to counties. Homelessness: $500 million for HAP round 7 contingent on accountability; $200 million for transitional rent from MCO tax.
- Supervisor Miley asked for worst-case scenario estimates; staff noted it's too early to quantify. Supervisor Tam requested that future briefings include best/worst case to inform Measure W allocation.
3. Federal and State Policy Changes Affecting Medi-Cal for Non-Citizens (Juan Matania, SSA; Dr. Kathleen Clanon, AC Health)
- Juan Matania presented four major changes:
- Enrollment freeze for UIS individuals (effective Jan 1, 2026): New enrollments for adults 19+ paused; current enrollees (51,200 as of Dec 2025) grandfathered unless they lose eligibility for >3 months. Breakdown by district, gender, top countries of origin.
- Reduction in dental benefits for UIS (July 1, 2026): Full scope dental removed for adults 19+; emergency dental only. Affects 74,000 individuals (including DACA, parolees, LPRs under 5-year bar).
- Redefinition of qualified non-citizens (Oct 1, 2026, from HR1): Only LPRs, Cuban/Haitian entrants, COFA migrants remain QNCs. Excludes refugees, asylees, battered non-citizens, etc. Affects 10,600 current enrollees. State budget may fund full scope without dental for those excluded, contingent on final budget.
- Premiums for certain UIS adults (July 1, 2027): $30/month premium for adults 19-59 with UIS to keep full scope (no dental); non-payment leads to restricted scope. Affects 57,600 current enrollees.
- Data provided by supervisorial district, age, gender, and top countries of origin.
- Outreach efforts: Health Navigators Project with 7 CBOs; healthyac.org website with interactive map.
- Dr. Kathleen Clanon discussed Health PAC (indigent care program): Currently 2,600 enrollees (income 138-200% FPL), budget ~$70 million/year. Section 17000 obligates county to provide care for medically indigent. If Medi-Cal enrollment drops from 407,000 to projected 240,000 by 2028 (per Alameda Alliance CEO Matt Woodrough), Health PAC could see increased demand. However, cost of care is much higher than current Health PAC budget; sustainability concerns. Discretion exists in defining eligibility and services, but long-standing policies may limit abrupt changes.
- Matt Woodrough (Alameda Alliance CEO) added: 407,000 total Medi-Cal enrollees; 7,000 UIS drop in January (preliminary); projected drop to 240,000 by 2028 if all changes implemented. MCO tax cap will significantly reduce hospital directed payments, affecting AHS.
- Supervisor Miley raised concerns about potential incentives for people to choose Health PAC over Medi-Cal to avoid work requirements, and about attracting residents from other counties. Staff noted they will monitor choices but may not know reasons. Supervisor Tam noted Health PAC is a limited county program, not equivalent to Medi-Cal.
Key Outcomes
- No formal votes or decisions were taken; all items were informational.
- Staff will return monthly to the joint committee with updates on HR1 implementation, data on enrollment impacts, and further analysis of state budget developments.
- Next month's meeting will include a presentation on CalFresh ABOD (work requirements) implementation.
- The board directed staff to provide best-case and worst-case scenario estimates for budget impacts to inform Measure W allocation.
- Staff will continue coordination with state and federal advocates, monitor legal challenges, and refine outreach strategies for upcoming policy changes.
- The committee acknowledged the need to minimize excessive meetings to allow staff to focus on implementation work.
Meeting Transcript
Good afternoon and welcome to the Alameda County Board of Supervisors special meeting that is a joint meeting of the Social Service and Health Committee. May I have roll call for January the 12th 2026? Supervisor Fortunato Bass. Present. Supervisor Miley. Present. Supervisor Town. Present. We have a quorum. Thank you. Did you need to go through instructions on participation? For in-person participation, the meeting site is open to the public. If you'd like to speak on an item, you can fill out a speaker's card in the front of the room and hand it to the clerk for remote participation, follow the teleconferencing guidelines posted at www.acgov.org. And if you'd like to speak on an item remotely, use the raise your hand function. Thank you. So we have three informational items. This is a long-awaited joint meeting that will help us understand and prepare for the impacts of HR1 on the state and on the county. So we'll start with the first informational item from Alameda County Health and Social Service. Good afternoon, Supervisors. Anika Chowder, Interim Director for Alameda County Health, and I'm joined by Director Ford from the Social Services Agency. So we have three presentations for you today. The first one is a backbone agencies update, followed by a budget update, and then a much uh lengthier one where SSA has done some deeper dives into some of the data and upcoming policy changes. So to start with the backbone agencies, the context here, you know, as you just reiterated in your last meeting, is that HR1 is really pushing some very significant Medicaid policy changes that are phasing in over a number of years. And there's a big impact on the Alameda County communities. So there's narrowed, eliminated, narrowed or eliminated eligibility for many community members, and then of course uh increased and new requirements, such as the work required requirements for people who do remain eligible. Um and that's uh there's also a lot of complex implementation challenges, so essentially uh, you know, any reduction in Medicaid eligibility or enrollment will result in revenue loss for our providers. Um it also means increased administrative complexity, especially for the social services agency, uh, as they're doing eligibility and enrollment. Um, there's a lot of policy and funding implications for the indigent care program, which is Health Pack, which is in our agency, and then of course, you know, one of the tricky things about doing this work is that there's so much that's dependent on state and federal guidance that hasn't yet come out. Um, and so, and as you even heard with the budget, you know, we don't have all the information and and we're trying to plan ahead. Um, so back in October, I believe it was the board designated um SSA and AC Health to help provide some backbone support to ensure coordination across our partners, and then report back regularly on Medi-Cal related efforts to this joint committee. So on the right here is just a little bit of uh uh, there used to be a big Venn diagram of this uh previously, but essentially just to give you a sense of uh context for the backbone is social services, AC Health, and we're working closely with our board offices. Um there's a core group of key health partners, uh, just because they're so large in the safety net space, which is Alameda Alliance for Health, Alameda Health System, and the Clinic Consortium, and then we've got a broader group of community providers to include the community provider advisory group, which is uh a meeting that uh was initially started by AC Health to join uh you know behavior health providers, homelessness providers, and public health providers in our system. Um, and director Ford has uh been able to join those meetings as well because so much of the focus is uh now on HR1. Um and uh we've got additional safety net partners, you know, in the social services space, and we're open to doing any ad hoc convenings as those happen. Um, and then sort of at the broader county governance level is where uh this committee comes into play where we want to keep you apprised of the things that are happening. So just recently, um, between SSA and AC Health, as you heard me list all the meetings. We talk about a lot of meetings, and we meet to coordinate. Um, we're also working on the implementation of some measure W funding that was allocated specifically for Medicaid outreach. Um, and uh we're under we're developing a MOU between our two agencies, which will uh provide some enhanced um access to data for our health pack team because they have a team of people who help people enroll in different insurance options. And so it would help that team to better refer people back to SSA. And then as I mentioned earlier, working with our uh large healthcare safety net providers, and really the work there is to you know continue to do data analysis so that we're all working from the same numbers, and you know, working to develop different strategies for how we're going to implement things that are coming down the pike. There's shared messaging work that I'll share a little bit about and um just coordinated medical outreach and engagement because that's probably the um biggest thing that I want to uh underscore is that uh the more we can prioritize medical outreach and engagement and enrollment retention, the better it will be for our system as a whole. Um can we ask questions as we go along, or did you want questions at the end? Um I think because this is going to be an extensive, let's ask them as we go along. So feel free. Okay, thank you. So before you leave this slide, um, how often does this backbone body meet? Um, so the uh SSA director and I have a regular meeting and regular check-ins, we see each other often. The meetings with the key health partners, those are currently every couple of weeks. Um, and I do want to thank the alliance for providing some additional um facilitation support for those.
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