Alameda County Board of Supervisors Public Hearing on AHS Proposed Reductions and Layoffs

On February 25, 2026, the Alameda County Board of Supervisors convened a public hearing under the Beilinson Act (Health and Safety Code 1442.5) to consider the Alameda Health System's (AHS) proposed reductions in workforce and medical services. The hearing featured presentations from AHS leadership, a response from SEIU 1021, extensive public testimony from over 115 speakers, and board member questions. The board ultimately voted to close public comment and continue deliberations to March 3, 2026, with Supervisor Miley telegraphing a potential $10 million county contribution and the formation of a working group to explore alternatives.

Public Comments & Testimony

• SEIU 1021 Presentation (Peter Maziac & Maria Bettencourt): The union argued that AHS has not sufficiently engaged with frontline workers or physicians, that the rationale for layoffs has shifted (initially citing HR1 cuts but later claiming overstaffing), and that AHS has not pursued $29 million in union-identified cost-saving ideas. They criticized the timing of executive bonuses and stated that proposed closures, especially of outpatient behavioral health programs, will shift costs to emergency services, jails, and other county agencies, ultimately costing more. They also highlighted that no actual HR1 cuts have taken effect this fiscal year and that federal delays in DSH and MCO tax cuts have created additional financial breathing room that AHS has not acknowledged.
• Physician Representatives (Dr. Benny Liu, Dr. Caitlin Bailey, Dr. Allen, and others): Multiple physicians read a letter signed by 332 clinicians expressing profound opposition to the cuts, citing lack of clinical input, systemic mismanagement, and risks to trauma center certification, cardiac care, birthing services, and other critical services. They stated that AHS systematically under-codes and under-bills, and that cuts will not save money but will increase costs elsewhere. Specific concerns included anesthesia shortages, vascular surgery coverage gaps, and the impact of phlebotomy and lab assistant cuts on blood culture contamination rates and emergency care.
• Public Speakers (116 registered, many patients and staff): Over three hours of public comment, alternating between in-person and remote speakers, with most speakers opposing the cuts. Clients of the Fairmont and Highland outpatient behavioral health programs described the programs as life-saving and essential for maintaining stability, preventing hospitalization, homelessness, and incarceration. Staff from multiple departments (lab, dietary, environmental services, nursing, therapy) warned that cuts to already understaffed units will degrade patient safety, increase errors, and lead to burnout. Several speakers noted that AHS management gave inconsistent numbers and that the proposed alternatives (e.g., 211, Fremont Hospital, Herrick) are inadequate for the chronic, severely mentally ill patients served by AHS. A few community members and advocates urged the board to consider systemic solutions such as the Billionaire Tax Act and to hold AHS executive leadership accountable.

Discussion Items

• County Administrator Introduction: Presented the two recommendations: 1) conduct the public hearing, and 2) designate AHS to provide 24-hour information service. Noted that the county allocates approximately $134 million to AHS ($83M for behavioral care, $44M for indigent care, $7M for other services).
• AHS Financial Update (CFO Kim Miranda): Reported year-to-date financials: breakeven of $700K vs. budgeted $9.5M deficit, but January showed an $11.5M loss. Revenue is ahead of budget, but expenses are $13.2M unfavorable due to higher labor costs and FTE counts (5,207 paid FTEs, 74 over budget). The line of credit is at $80M, projected to max at $95M by June 30, and to exceed the limit by $60M in September 2026. The CFO attributed pressures to the $42M AB 85 realignment payback, reduced John George funding, and high inflation without matching government fee increases.
• Reduction in Force Overview (CHRO Jet Chapman): The initial 372 positions targeted were reduced to 211 after voluntary resignation (31) and retirement (43) programs. Impact bargaining with unions continues. Notified unrepresented employees on Dec 19, represented on Jan 6. Effective separation date is March 9, 2026.
• Service Closures/Reductions (COO Mark Fratsky & Department Heads):
  • Fairmont Cafeteria Closure (Rosie Rojas): Saves $176,000/year; low customer volume; 2.7 FTEs impacted.
  • Telesitter Program Suspension (Dana Littlepage): Saves $395,000/year; did not reduce physical sitter costs ($3.17M annually); 42% utilization.
  • Health Advocates Program Closure (Lily McRae): Saves $890,000/year; 6.5 FTEs; services include connecting patients to social resources (housing, food, legal). Alternatives said to be 211 and internal resources.
  • Complex Care Management Reduction (Lily McRae): Saves $1.2M/year; 6.6 FTEs; reduces capacity for high-need patients with SMI, homelessness, etc.
  • Plastic Surgery Reduction (Dr. Lisa Laurent): Reduces from 1.4 to 0.6 FTE, saving $350,000; maintains trauma coverage; actual annual case volume disputed by Dr. Alan (210 cases vs. AHS's 36-40).
  • Behavioral Health Outpatient Services at Fairmont & Highland (Patty Esposeff): Programs lose $3.6M in operating revenue vs. $7.2M costs (excluding overhead); 175 clients served; patients with chronic SMI referred to other programs but alternatives lack capacity, transportation, interpreters, and long-term support.
• Board Questions:
  • Supervisor Tam: Asked about patient mix (60% Medi-Cal, 92% government payers, 1.7% uninsured), transition plans for programs, and the impact of cuts on trauma center certification. Heard testimony that pre-existing understaffing will be worsened.
  • Supervisor Fortunato Bass: Queried timing of financial pressures relative to HR1, bonuses ($7M based on prior year performance), and response to union cost-saving ideas. AHS replied that bonuses were tied to FY 24-25 performance and that they are open to exploring ideas but have not yet implemented.
  • Supervisor Marquez: Asked about the rationale for adding 114 FTEs last year, vacancy rates, layoff notice process, and behavioral health patient tenure (some patients in wellness program for over 10 years). Noted additional upcoming cuts due to Prop 1 and the need for coordination with county behavioral health.
  • Supervisor Miley: Stressed the need for collaboration and expressed concern about the disconnect between executive decisions and frontline knowledge. He indicated he would propose $10M in county funding and a working group at the next meeting.
  • President Halbert: Arrived late but emphasized health care as a human right, the need to maximize revenue and streamline operations before cuts, and the importance of listening to experts and the public.

Key Outcomes

• Motion to Close Public Comment and Continue Deliberations: Supervisor Miley moved to close public comment and continue the matter to the Board's next regular meeting on Tuesday, March 3, 2026, at 2:00 p.m. as a set item. The motion was seconded by Supervisor Fortunato Bass and passed unanimously (4-0, with President Halbert excused and later present).
• Telegraphed Proposal for March 3: Supervisor Miley indicated he will propose:
  1. County contribute $10 million to AHS to curtail layoffs.
  2. Formation of a working group with two supervisors, AHS representatives, and labor to collaboratively address the budget over the next two fiscal years.
  • Supervisor Fortunato Bass added interest in lobbying for state relief, renegotiating the net negative balance and behavioral health payment withholdings, and seeking input from Alameda County Health.
• Closed Session Report: Earlier in the meeting, the board reported no action from closed session, but later corrected to state that the board authorized joining an amicus brief in Trump v. Barbara supporting birthright citizenship (4-0 vote, Halbert excused).
• Continuation: The public hearing remains open for board deliberation at the next meeting; public comment is closed. The board will consider the proposals and may take action on March 3.