Community Health Committee Meeting - October 23, 2025

The Community Health Committee convened on October 23, 2025, to address urgent public health concerns and review key city initiatives. The meeting featured public testimony regarding heat and cold-related fatalities, followed by a presentation on the proposed update to the San Antonio Film Incentive Program. The committee also received a critical briefing from Metro Health officials on the impending expiration of the Medicaid 1115 waiver, which threatens significant funding reductions to chronic disease prevention, oral health, and violence intervention programs. The committee discussed strategies for collaboration, workforce retention, and potential funding shifts to mitigate these impacts.

Consent Calendar

• Minutes Approval: The committee unanimously approved the minutes from the previous meeting following a motion and second with no opposition.

Public Comments & Testimony

• Diana Lopez (District 2 Resident/Advocate):
  • Position: Expressed urgent concern regarding the lack of data tracking for heat-related deaths, advocating for immediate interagency collaboration and accurate data collection to allocate proper resources.
  • Testimony: Highlighted that while heat is seasonal, data gaps prevent effective intervention for unhoused residents and outdoor workers. Noted that Houston launched a tracker forum for heat-exacerbated illnesses and urged the committee to prioritize this before the next heat season.
• Erica Alvarado (District 2 Resident, Southwest Workers Union):
  • Position: Expressed full support for continuing the work on the Chronic Care Registry (CCR) to track heat-related deaths transparently.
  • Testimony: Emphasized that despite cooling temperatures, urban heat islands remain a critical threat, particularly for unhoused neighbors and residents in downtown-adjacent areas. Urged the committee to maintain the urgency started by the government committee.
• Molly (Public Commenter):
  • Position: Expressed strong support for tracking both heat-related and cold-related deaths, citing the tragedy of Patricia Lawrence.
  • Testimony: Argued that 50-60 degree temperatures pose severe, life-threatening risks to those without shelter or resources, as evidenced by recent cold-related fatalities.

Discussion Items

• San Antonio Film Incentive Program Update (Presenter: Crystal Jones):

  • Proposal: Crystal Jones presented a proposal to increase the city's film incentive rebate from 7.5% to 10% and expand eligibility to include commercials.
  • Key Updates:
    • Incentive Structure: Maintained the $250,000 budget cap but increased the rebate percentage to remain competitive with Houston (10%) and other Texas cities; introduced 2% "uplifts" for hiring 35% San Antonio residents and 5% veterans.
    • Workforce Development: Proposed a mandatory requirement for funded productions to partner with local higher education institutions (e.g., UTSA, Alamo Colleges) for internships or panel discussions.
    • Economic Impact: Highlighted 216 estimated local hires and $600,000 in local spend for current projects; noted the state's 10-year incentive extension ($300 million) as a catalyst for this update.
  • Councilmember Positions:
    • Councilmember Ricastillo (Chair): Expressed support, asking for clarification on local production infrastructure (noting a lack of large sound stages but existing small co-working spaces) and confirming the budget source is the Hotel Occupancy Tax.
    • Councilmember White: Expressed full support, emphasizing the economic opportunities and the need for a streamlined application process. Stated skepticism regarding increasing the $250,000 cap immediately; suggested testing the 10% rate first to see if the fund is exhausted before seeking additional funding.
    • Councilmember Castillo: Expressed support, highlighting San Antonio's unique historical and cultural assets (Chicano history, music) as a differentiator for filmmakers. Advocated for leveraging local artists for set designs and costumes.
    • Councilmember Alderete Gabito: Expressed support for the local hire and veteran priorities. Raised the importance of integrating performing arts programs in public schools (e.g., Taft High, Edgewood, Stafford) and nonprofits like District 7's initiatives.
    • Councilmember White (Comment): Emphasized the need for coordination across the city and county to maximize the economic and creative potential, noting the success of the "Say a Little Prayer" film in utilizing local artists and musicians.

• Medicaid 1115 Waiver & Metro Health Update (Presenters: Dr. Claude Jacob, Marjorie White):

  • Context: Dr. Jacob briefed the committee on the impending expiration of the Medicaid 1115 waiver reserves at the end of FY26 (Sept 2026), which accounts for ~$8 million (25% of grant funding) and impacts ~80 staff across eight program areas.
  • Specific Impacts (Diabetes Program):
    • Funding: Marjorie White detailed a projected 72% funding reduction for the Diabetes Prevention and Control Program, dropping from ~$1.6M (FY26) to ~$465k (FY27).
    • Staffing: Projected reduction from 12 staff to 3 Health Program Specialists (9 positions are waiver-funded).
    • Capacity: Anticipated 60% reduction in workshop capacity and community engagement events.
    • Programs at Risk: Oral Health ($1.5M budget, 39 staff), Stand Up SA (violence prevention, 50% staff cut), and STI prevention services.
  • Council Positions & Inquiry:
    • Councilmember White: Expressed concern over the cuts and emphasized the need for collaboration with Bexar County University Health and other hospital systems to explore shared service models. Questioned whether programs would sunset or be prioritized based on effectiveness.
    • Councilmember Castillo: Called for a paradigm shift in viewing public health as a core economic driver rather than a crisis. Advocated for using the City General Fund to support Metro Health to prevent an unhealthy workforce and poverty cycles. Proposed using District 5 carry-forward funds to support the insulin cost-share program.
    • Councilmember Alderete Gabito: Expressed strong concern over the elimination of oral health and the reduction of violence prevention services (Stand Up SA). Emphasized the need for data on the direct effects of these cuts on public safety (gun violence) and resident health outcomes. Urged understanding if community partners have the capacity to absorb these clients.
    • Councilmember White (Comment): Reiterated the necessity of upstream prevention and cross-governmental coordination to manage finite resources. Highlighted the fatigue of the workforce and the need for professional development to mitigate burnout.

Key Outcomes

• Film Incentive Approval: The committee approved the recommended changes to the San Antonio Film Incentive Program, including the increase to a 10% base rebate, 2% uplifts for local hiring and veterans, and expanded eligibility for commercials. This item is directed to the November 6th City Council agenda for final approval.
• Metro Health Briefing: No formal vote was taken on the Medicaid waiver issue. The committee accepted the briefing on the fiscal fragility facing Metro Health. Key directives included continuing the conversation on potential General Fund support to offset the waiver loss, exploring collaborations with Bexar County and hospital systems, and awaiting further data on the specific impact of cuts on public safety and health outcomes.
• Upcoming Actions: A follow-up presentation on the Diabetes program and other impacted sections is scheduled for future meetings. A virtual site visit for national public health reaccreditation is scheduled for the day following the meeting.