Alameda County Joint Social Service and Health Committee Special Meeting – March 10, 2026

The Alameda County Board of Supervisors held a Joint Social Service and Health Committee special meeting on March 10, 2026, to receive two informational presentations. The first presentation covered state and federal policy changes to Medi-Cal, including an enrollment freeze, dental benefit reductions, work and community engagement requirements, and impacts on non-citizen residents. The second presentation provided an annual update from the Alameda County Council for Age Friendly Communities, highlighting housing, health, digital inclusion, transportation, and advocacy efforts for older adults. Public comments raised concerns about a proposed single-provider contract for the Area Agency on Aging's Information and Assistance services and insufficient transparency in the RFP process.

Consent Calendar

• [None mentioned]

Public Comments & Testimony

• Wendy Peterson (Senior Services Coalition) spoke on the age-friendly annual report, raising alarm about the Social Services Agency's Notice of Intent to award the AAA Information and Assistance contract to a single provider. She called it an unprecedented departure from past practice that would re-configure the service landscape and be catastrophic for locally embedded providers without countywide reach.
• Anna Baptist (City of Oakland) stated that the City of Oakland and other providers have delivered information and assistance for decades (Oakland for over 20 years). She argued that centralization would not create efficiency because community-based organizations know their communities better. She further asserted that the RFP did not clearly state it would be single-source; on page 1713 the RFP said multiple awards may be made, and at the bidders' conference staff said they did not have a set number of organizations and that there could be multiple awards. She criticized the RFP process as lacking transparency.

Discussion Items

1. State Budget & HR1 Impacts on Medi-Cal

• Juan Ventania, Emilia Sanders, and Tammy Lu (SSA) presented updates on Medi-Cal policy changes affecting non-citizens and work/community engagement requirements.

  • Enrollment freeze for individuals with unsatisfactory immigration status (UIS): Effective January 1, 2026. As of late February 2026, 49,910 individuals were enrolled in full-scope Medi-Cal as a result of past expansions, a decrease of 1,290 from December 2025. The largest reason for the drop (70% of sampled discontinuations) was failure to complete annual renewal. Exemptions include pregnant individuals through postpartum and those permanently residing under color of law (PRUCOL), among others.
  • Reduction of dental benefits for UIS individuals: Effective July 1, 2026, full-scope dental will end for UIS adults 19+ (except pregnant/postpartum). 71,790 individuals are potentially impacted, down 2,210 from December. Emergency dental coverage will remain.
  • Redefinition of qualified non-citizens (QNC): Effective October 2026, QNC status will be limited to lawful permanent residents, Cuban/Haitian entrants, and COFA migrants. Refugees, asylees, battered non-citizens, and others will lose QNC status, potentially moving to restricted-scope Medi-Cal unless state funding is provided. An estimated 8,960 individuals will be affected, down 1,640 from December.
  • Health Navigators Project (CBO partnerships): From July–December 2025, CBO partners assisted with 1,453 new enrollments (on 1,149 cases) and 2,957 Medi-Cal renewals (on 1,275 cases). Two success stories were highlighted about helping newly arrived families and individuals navigate constant policy changes.
  • CMS data sharing with DHS/ICE: A federal court ruled (Dec. 2025) that CMS may share limited data with ICE only for individuals not lawfully residing in the U.S., but if the data cannot be separated out (e.g., includes lawful permanent residents or U.S. citizens), it cannot be shared for immigration enforcement. The lawsuit is ongoing.

• Work and community engagement requirements (HR1): Effective January 1, 2027, for individuals aged 19–64 in the MAGI New Adult Group (incomes over 109% FPL). Exemptions include parents/caretakers of a child under 13, pregnant/postpartum (12 months), individuals receiving Medicare A/B, American Indians/Alaska Natives, and medically frail individuals. Qualifying activities include earning ≥$580/month (80 hours at $7.25/hr federal minimum wage), employment ≥80 hrs/month, school attendance, or community service. The process involves a 30-day look-back at application and a 6-month renewal window.

  • Preliminary data (Tammy Lu): 158,900 residents are subject to the work requirements (down 2,100 from early February). The majority of the decrease was due to renewal failure. Age group 26–49 is most affected; more males than females are subject to work requirements. Top countries of origin among affected: Mexico, China, Guatemala, Vietnam. About 15,100 individuals may meet an exemption (largest group: caring for a child under 14, ~9,500). About 55,900 may meet work requirements through income, employment, or school. About 87,900 individuals currently do not meet an exemption or a qualifying activity (58% of the subject population). District 3 has the highest numbers. Full implementation by 2030 is projected to reduce statewide Medi-Cal caseload by 12.24% (~50,300 in Alameda County).
  • Future enhancements: State is developing an exemption/work reporting form, exploring data sources (EDD, IRS, Equifax, CalFresh/CalWorks, veteran service history, etc.) and gig economy data via TRUVE, and looking at managed care data. County is optimizing data queries and convening a workgroup for staffing, training, and outreach. State text messaging campaign began February 2026 (targeting those with Jan/Feb 2027 renewals).
  • Supervisor concerns and questions:
    • Supervisor Fortunato Bass asked clarifying questions about the $580/month income threshold (confirmed it is an alternative to 80 hours of employment). She emphasized that the workgroup needs to be “all hands on deck” and asked for regular updates to the board.
    • Supervisor Miley asked about the possibility of enrollment after the 3-month grace period (only restricted-scope would be available). He suggested creating a county program to help individuals meet the work/community engagement requirement (e.g., volunteering for litter pickup). He also asked about eligibility worker caseload (2,000 per worker) and vacancies (~140 FTE). He expressed concern that 87,900 people could lose coverage and urged proactive help.
    • Supervisor Tam asked about the timeline for when displaced refugees could regain full-scope (when they change to another qualified status) and whether the numbers from SSA align with broader Alliance projections (confirmed by Andrea Ford: the numbers are on par with earlier worst-case scenario projections, but the 12.24% reduction is a phased figure, not absolute). He noted that “any number is bad” but appreciated the phased approach.

2. Alameda County Council for Age Friendly Communities – 2025 Annual Update

• Faith Battles (Assistant Agency Director, Department of Adult and Aging Services) and Kimmy Watkins Tart (Director, Alameda County Public Health) presented the update, covering age-friendly domains aligned with the state’s Master Plan on Aging, Vision 10X, and AARP domains.
  • Housing: Over 8,000 older adults served via HMIS in FY23-24; 1,200 obtained housing. Among new homeless entries, 1,200 were 50+. Over 4,000 served were Black/African American (disproportionate). 22% of older adults returned to homelessness within two years (7 ppt higher than county average). The Home Safe program has dispersed over $8 million countywide, enrolling nearly 500 clients. FY25-26 allocation is $2.75 million. Examples included funding a $22,000 home cleanout after a red tag, water heater replacement, and bathroom renovation. UCSF Vinioff study found 93% of those housed at entry remained housed at exit; 58% unhoused at entry were housed at exit. Alameda County served twice as many clients as LA County.
  • Health and community supports: Healthy Brain Initiative (700k grant, July 2023–June 2025) conducted 110+ training/listening sessions with nearly 1,700 care providers (550 family caregivers, 300 first responders). Triple A delivered 623,000 home-delivered meals to 3,600+ older adults; 200,000 congregate meals to 2,700+ seniors. Legal assistance provided to 3,100 older adults. HICAP served 2,200 Medicare beneficiaries. Advocacy included pushing for increased Medi-Cal reimbursement rates for adult day services and funding for Alzheimer’s disease centers. Partnership with Sutter Health to promote age-friendly health systems.
  • Digital inclusion: Two grant applications (federal $4M NTIA Digital Equity Grant; state $1.2M digital equity plan) were terminated due to federal funding shifts. Council remains active via Oakland Undivided’s transition to East Bay Broadband Consortium and CPUC’s California Advanced Services Fund (public housing account). Exploring device refurbishing with Alameda County ITD. Published an older adult data resource directory.
  • Civic participation & economic security: Legislation and Advocacy Committee reviewed state budget proposals and took positions on key bills. Four bills passed: AB 561 (elder abuse protective orders), AB 1069 (emergency shelter access for older adults), SB 470 (extending remote meeting attendance through 2030), AB 960 (allowing bedside visitors for patients with dementia). Finalized issue briefs on Alzheimer’s and older adult employment. Identified a critical gap: eviction data does not report age at time of eviction. Launched a client story submission campaign for advocacy.
  • Transportation: Participated in ACTC listening sessions to reflect older adult needs in regional plans. Attended AC Transit community meeting to oppose paratransit reductions; elected board preserved all services for the year.
  • Demographics: Nearly 385,000 residents are 60+; projected to reach 600,000 by 2040 (70–80% growth). Half of single older adults report not affording basic living costs. Over 69,000 residents 65+ projected to have Alzheimer’s/dementia by 2060. 2,406 older adults served by behavioral health in FY22-23; need is expected to grow.
  • Supervisor Miley’s feedback and questions: He expressed difficulty gauging overall progress on age-friendliness without a dashboard with baseline data from 2017. He noted that the report felt anecdotal and requested a more quantitative dashboard. He asked about partnerships with Spectrum (LIHEAP) and the food bank—confirmed they have participated at times. He noted the absence of these prominent food programs from the report and felt the council should highlight such priorities. He asked about the Master Plan on Aging: it is a state plan with no mandates and no funding. He urged the council to advocate for state funding tied to the plan’s priorities. He asked about the council’s role vis-à-vis homelessness: HH (Housing & Homelessness) is an active council participant; data shows disproportionate homelessness among older adults, but also that older adults are heavily represented among those placed into permanent housing. He asked about behavioral health involvement—confirmed BH is an active council member and will continue to be a focus. He suggested the board may need to reaffirm its commitment to age-friendliness and cross-departmental collaboration. He asked about Measure W funding for older adults: the council provided recommendations but did not request specific funding. He noted that roughly 2 million of the 25 million Measure W allocation went to senior meals (SNAP program). He asked for a percentage or total—staff could not give a figure but said some older adult investments were made via the Essential Services Fund and the refreshed Home Together plan. He expressed concern that older adults might not support future Measure W measures if their needs are not addressed.
  • Supervisor Fortunato Bass thanked staff, praised the website and data resource directory, and asked about longevity trends. Battles responded that people are living longer but not healthier, citing IHSS/APS clients in their 70s–90s, increasing isolation, and high costs of aging (especially for vision, dental, hearing, foot care not covered by Medicare). Kimmy Watkins Tart added that life expectancy is unequal by race/ethnicity, leading to shorter, sicker lives, and that systems are not equipped to handle a large, older, sick population with few family supports.
  • Supervisor Tam thanked staff and specifically praised the advocacy that preserved paratransit services. He asked about the link between affordability and Medi-Cal/Medicare coverage: Battles confirmed that 50% of seniors reporting inability to afford basics likely rely on Medi-Cal in addition to Medicare, but noted subsidized housing is often unavailable and that many seniors pay >30% of income on rent, leading to a snowball effect of missed care and food. She explained that the Home Safe study found that even with flexible funds, the high cost of living limits impact. Tam asked about how HICAP counseling offsets uncovered costs (e.g., hearing aids, dental, podiatry)—Battles said that legal assistance and HICAP help but there is no long-term plan for persistent issues, and there are programs but they are insufficient for all who need them. Kimmy Watkins Tart added that without these supports, health becomes more compromised, especially for those who fall into a “hole” between being on Medicaid and having some money (e.g., home owners who cannot maintain their homes).

Key Outcomes

• No formal votes taken (informational items).
• Directives and next steps:
  • The presentations will inform ongoing board oversight of Medi-Cal eligibility changes and age-friendly initiatives.
  • Supervisor Miley asked staff to consider creating a county program to help the ~88,000 individuals meet work/community engagement requirements, such as volunteer opportunities for litter cleanup. Staff noted they are awaiting state guidance and federal approval for county opt-in supports.
  • Supervisor Miley requested that the board be provided with a formal dashboard for age-friendly progress, using baseline data from 2017.
  • Supervisor Miley suggested the board may take formal action to reaffirm the importance of age-friendliness and cross-departmental collaboration.
  • Supervisor Tam and Fortunato Bass asked that the committee be kept updated on the Medi-Cal workgroup’s plans and any resource needs.
  • The Social Services Agency’s decision to award the AAA Information and Assistance contract to a single provider will be brought to the full Board of Supervisors at a future date, currently undetermined. Multiple supervisors expressed strong concern and indicated they may reject the award without sufficient justification.