[{"_1":2,"_111":-5,"_112":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87,99],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},"mediaId",6705719,"mediaKeyId","5327941-691101885c856270f86b285aa5de404b","parentId",5327941,"title","San Francisco Health Commission hears warning of large federal and state Medicaid cuts, local impacts uncertain","audioSeconds",226,"startMs",2240000,"endMs",2466000,"viewUrl","/Search/View?dp=1&key=5327941-691101885c856270f86b285aa5de404b&start=2240&end=2466","thumbnailUrl","https://assets.pipeline.soar.com/5327941-691101885c856270f86b285aa5de404b/thumbnail_2240000.jpg","articleUrl","/articles/6705719/San-Francisco-City/San-Francisco-County/California/San-Francisco-Health-Commission-hears-warning-of-large-federal-and-state-Medicaid-cuts-local-impacts-uncertain","mediaUrl","https://secure.pipeline.soar.com/6705719-cd0eeed1bf548569fe62d653ec70ef64/orig.mp4?Expires=1770440065&Signature=DkzRpJqcLfnSq73A67HDPuoR7o2L3Mjl0vgWoDp~cAZpaWDIf-sxh4jUuo2vraHnU8fIgGLekwkBrF3Qld5tvtg7ONlJkm2zAC8h9L90sYKcm8FG0610AeS9~9hwjNBDKY98HwlFvujaplq~mcrhgjTxY6NqMZv50SzaMqS0hPorZLQthy95~gHWRgPUL04IMfke84lk07u-xlgY5LVnh857FPwV-Sx0cE7ebufv3XReJUtgMoUI7-RIudTMvF2hEwD~oYEQmYrUBVl4L4eZOFkjt2RBdjbwvcza~-Gsa5HzTzT5EcxHVzW4ZfL7ds4LozcVs6IogAoDQZQ6LSrXzg__&Key-Pair-Id=KUT5TJCACFTXG","author","City of San Francisco","date","2025-07-07T00:00:00Z","article","At a San Francisco Health Commission meeting, Deputy Director Naveena Baba of the Department of Public Health briefed commissioners on recent federal and state budget actions she said will shrink Medicaid coverage and change payment rules, with effects beginning as early as 2026.

\"These are the most significant cuts that Medicaid has faced since its inception,\" Baba told the commission, summarizing the federal reconciliation bill and the California budget actions she has reviewed. She said the department is still completing fiscal analysis and will return with more precise local estimates.

Baba outlined a multi-year timeline the department expects based on current federal and state proposals and passage to date. Among the items she described: a January 2026 state restriction that would freeze Medi‑Cal enrollment for adults 19 and older with what the state calls \"unsatisfactory immigration status\" unless they were enrolled prior to that date; a shift for that population from prospective payment system rates for federally qualified health centers to fee‑for‑service; a freeze on adult dental coverage taking effect July 1, 2026; and a federal reduction in the federal medical assistance percentage (FMAP) for emergency Medicaid from 90% to 50% beginning in 2026.

Baba said further changes would follow in 2027 and 2028, including a January 2027 state requirement for a $30 monthly premium for certain adults (described in the presentation as the UIS population), the start of federal Medicaid work requirements in January 2027 (80 hours per month for adults 19–64), and more frequent eligibility redeterminations (every six months). She said federal directed payments to states would be reduced starting in 2028, declining in stages until managed‑care payments are tied closer to Medicare benchmarks, and that the federal provider tax would be lowered incrementally until it reaches 3.5 percent.

Baba and commission members cited broad national estimates presented in the briefing: about 12 million people could lose Medicaid over the next decade because of the federal changes, and the likely end of enhanced ACA premium tax credits could lead to about 5 million more people losing coverage, for a combined estimate of roughly 17 million people nationally. Baba cautioned these are national estimates and that local effects depend on state actions and implementation details.

Locally, Baba said the city and county are already preparing: the Board of Supervisors was voting on the city's budget the next day and the city has set aside a contingency fund she described as roughly $400 million to mitigate some federal cuts. She said DPH has begun fiscal modeling but that the final local impact depends on pending state emergency sessions and any changes legislators make in response to federal action.

Commissioners asked for the department's written notes and for outside summaries from lobbying and public‑policy groups; Baba said DPH would distribute analyses and follow up with more detailed presentations once federal and state details firmed up.

The commission did not take formal action on Baba's report during the meeting; commissioners thanked staff for the update and requested continuing briefings as the fiscal picture evolved.

The presentation and discussion emphasized the need for more precise local modeling and further outreach to partners and commissioners once the state and federal implementation plans are finalized.","mediaType","Video","parentTitle","City of San Francisco - Video Open Video Only in Windows Media Player - Jul 07, 2025","oneSentenceSummary","Deputy Director Naveena Baba told the Health Commission that recent federal reconciliation legislation and the state budget will reduce Medicaid funding and eligibility in stages beginning in 2026, potentially shrinking coverage and shifting costs to local providers and the city.","taxTitle","San Francisco City, San Francisco County, California","taxId",5751,"location","headline","","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},6705705,"Votes at a glance: Health Commission approves minutes, honors two long‑serving DPH leaders, adopts consent calendar",7521,76000,7597000,"/Search/View?dp=1&key=5327941-691101885c856270f86b285aa5de404b&start=76&end=7597","https://assets.pipeline.soar.com/5327941-691101885c856270f86b285aa5de404b/thumbnail_76000.jpg","/articles/6705705/San-Francisco-City/San-Francisco-County/California/Votes-at-a-glance-Health-Commission-approves-minutes-honors-two-longserving-DPH-leaders-adopts-consent-calendar","https://secure.pipeline.soar.com/6705705-fb5a533992381dabe24a593d77827eae/orig.mp4?Expires=1770440065&Signature=hAaSo9vB-rKGPhL3~iF2ctKbzt6p8F95ezImfGKQdBayIM2x6L3yU7hwkilovBRgaYr~tvk2yJahXppZZ7qrL3Ri4feS~RcekCw2FEgkEKwAuUC06Aeu82-78dWsSgmAN9XoAOZDAis5wn0Z4oHLBUEWJjofPHMONpOI2M7VmEdrrQJFIdZtUDZZFcadgXADEPnvapSbJ019OCk5hnmM0Xalk2t7c1WPezMygZHBWPaGPJMUghjYv9RsAwRaT8MHGgItn7Fh2UHJ55Us3di7vkLketbH~YRT3fcVPk5gUllZbsNkN7rqGHaUUfecj-mHKJbCAAxb2NbliifUeju6Bg__&Key-Pair-Id=KUT5TJCACFTXG","The San Francisco Health Commission took several routine and ceremonial votes during the meeting.

Minutes: The commission approved the minutes from its June 16, 2025 meeting by voice vote after no public comment was offered on that item.

Resolution honoring Maggie Rykowski: Commissioners unanimously approved a resolution honoring Maggie Rykowski for more than 30 years of service at the Department of Public Health, including leadership roles at Zuckerberg San Francisco General Hospital, Laguna Honda Hospital and in the department's compliance and privacy offices. The resolution notes military service in the U.S. Navy Reserve and leadership during federal emergency responses; the commission approved the resolution by voice vote with no recorded roll‑call tally and no remote public comment.

Resolution honoring Patrick Fosdell: The commission unanimously approved a resolution honoring Patrick Fosdell for a 34‑year career in San Francisco environmental health, including work on hazardous materials programs, retail tobacco control, massage enforcement legislation, and pandemic response operations. The resolution was approved by voice vote with no public comment recorded on the item.

Consent calendar: The commission's consent calendar — including recommended policies and contract items reported to the Finance & Planning Committee — was approved by voice vote. Items discussed at committee included sole‑source administrative contracting clarifications and a Progress Foundation contract for transitional residential treatment services in development; commissioners requested follow‑up on site selection and program startup timelines for that contract.

Closed session: The commission voted to enter closed session; items discussed in closed session included a settlement recommendation that the commission voted to recommend for Board of Supervisors approval. Because the matter was discussed in closed session, details were not disclosed on the public record at the meeting.

Each of the above items was approved by voice vote; the meeting transcript records \"aye\" responses and no roll‑call tallies for these agenda votes.","The commission approved routine minutes, adopted resolutions honoring Maggie Rykowski and Patrick Fosdell for long public‑health careers, approved the consent calendar and voted to enter closed session.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},6705710,"Public commenter warns commission about cumulative effects of digital surveillance on health",244,1966000,2210000,"/Search/View?dp=1&key=5327941-691101885c856270f86b285aa5de404b&start=1966&end=2210","https://assets.pipeline.soar.com/5327941-691101885c856270f86b285aa5de404b/thumbnail_1966000.jpg","/articles/6705710/San-Francisco-City/San-Francisco-County/California/Public-commenter-warns-commission-about-cumulative-effects-of-digital-surveillance-on-health","https://secure.pipeline.soar.com/6705710-4882c27437605a99fc8428e13ad46390/orig.mp4?Expires=1770440065&Signature=Phh3CV6PBjQwlW2TQqdPuLfBvtDGx7OSi8lcbTZYaaTKyIOd~SEouUwFuqm4Ifc~HYIRkEZQVRDjxDlZ2OoT9aaRO0IFSXEudKKt27-Zk2BWob4UsTjZXpcbqAX~OFnK11iYO~zDKJ2mgaU6TWbC7zm4gRf-bpwt1xj6BcrJZzVzTytvWT-d9gtXFp4HdErnnxJh-2RGUstiADdYtiRbcvDLS1uL8CJjlEUWOhAjcw7x84gtEnhKizDO7nEpYT3arqIoJeXE8O6Pn~jQPB6cK5G9a3tB-WoEiBSkjHDJMVPqUc4xJY8AqNME09KIeeaDk9i3L5yt09RG0sUpGEUxAA__&Key-Pair-Id=KUT5TJCACFTXG","During the general public comment period, a speaker identified as Chris Klein addressed the Health Commission with concerns about multiple forms of digital surveillance and their potential public‑health effects.

Klein described a broad set of digital activities — which he called \"surveillance\" — including health surveillance, probation and parole monitoring, research questionnaires, and vendor platforms (SurveyMonkey, Mailchimp and others). He said the layering, or \"stacking,\" of different surveys and data‑collection tools can create constant prompts that disturb sleep and increase anxiety.

\"So the noise pollution is the combination of all this,\" he said, arguing that repeated, overlapping outreach can raise a person's baseline stress level and, in some vulnerable cases, lead to substance use or other harms. Klein urged department heads to convene an \"emergency meeting\" to determine an appropriate hierarchy for handling data collection and to reduce unnecessary third‑party access to sensitive data.

Klein named a range of vendors he sees in systems integration and public‑health data (EpiX, Epic, FirstNet, Bitfocus, RGB Spectrum, SurveyMonkey, Survey Gizmo, Mailchimp) and asked the commission to push for clearer local coordination so that multiple systems do not compound burdens on community members.

The commission did not take action on the public comment; commissioners and staff said they would note the request and indicated cross‑departmental coordination would be needed to investigate the concerns raised.","A member of the public told the Health Commission that overlapping digital surveillance systems increase anxiety and may contribute to substance use; the speaker urged city departments to coordinate and reduce \"noise pollution\" in data collection.",{"_33":100,"_35":36,"_37":38,"_39":101,"_41":102,"_43":103,"_45":104,"_47":105,"_49":106,"_51":107,"_53":108,"_55":56,"_57":58,"_59":109,"_61":62,"_63":64,"_65":110,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},6705715,"Jail health services outline CalAIM rollout, early billing returns and care strategies",1431,3327000,4758000,"/Search/View?dp=1&key=5327941-691101885c856270f86b285aa5de404b&start=3327&end=4758","https://assets.pipeline.soar.com/5327941-691101885c856270f86b285aa5de404b/thumbnail_3327000.jpg","/articles/6705715/San-Francisco-City/San-Francisco-County/California/Jail-health-services-outline-CalAIM-rollout-early-billing-returns-and-care-strategies","https://secure.pipeline.soar.com/6705715-5ec61258a5d2db9a06fbde97546008c7/orig.mp4?Expires=1770440065&Signature=FcAtY-Jv0bAiAp65fSVx1D78EXP291uNjK7VqCZ~Cx5xEEIOgBajX80WirQGDnoCwhi7rpXBf8ZxUAG7Lnc-0nBrvosO5gSYo-mV0MuLI2fINs~6cFM7Ee4Nyuuzpkp4ACYyIsJoDpHE~ueIVQI7yVftTsONRaDMpU9JBBDEiKM3dRvjJ1pnVxNpwmKEk~RHrTPS3lU7d2xy23JfiCopwiTz~fNkaa7u8WY0tV8zViUswucZL0NGAXXYFwmG7od5ev7XEOH0w2HkBXUJoqwG~Y4ui9cHiSKemaNO1H6zBVUOAsPhJ0BRSW7tsgp5qjhCtZrowq5S0X19zPv7hFOaew__&Key-Pair-Id=KUT5TJCACFTXG","Dr. Michelle Pratt, chief of Jail Health Services, presented a detailed update to the San Francisco Health Commission on the section's work, the CalAIM justice‑involved implementation and early billing results since launch.

Pratt explained why DPH provides jail health care and cited legal precedent: \"The only people who have a constitutional right to health care are people who are incarcerated,\" referencing Estelle v. Gamble and California Title 15 requirements that regulate jail health care. She described the department's mission to mitigate structural inequities and provide integrated clinical services in partnership with the Sheriff's Office.

Pratt said the jail population has risen since mid‑2023, with roughly 15,000 bookings last year representing about 10,000 unique patients and a current daily census near 1,300. She said the jail's median length of stay is about 2.71 days, stressing that many people are in custody only briefly, which complicates linkage to community care.

Jail Health Services provides primary and urgent care, dentistry, substance use disorder (SUD) treatment including medication for opioid use disorder (MOUD), psychiatric services, infection control (TB, mpox, STIs), and discharge planning. Pratt described the Stabilization, Treatment and Recovery (STAR) model and new care coordination under CalAIM that emphasize screening on intake, medication initiation when appropriate, and warm handoffs to community supports such as BEAM, Juno navigators, Ward 93 and Team Lilly at Zuckerberg San Francisco General Hospital.

Pratt said DPH received approximately $4.5 million in state startup funds to build an Epic redesign, eligibility and billing processes necessary for CalAIM billing and care coordination. The CalAIM justice‑involved program launched April 1; Pratt reported that initial claims activity suggests the department may realize more revenue than earlier projections. \"We thought we would probably bring in about $7.6 million through our billing, but based on the first three months, it'll be closer to $11 million,\" she said, while noting claims were submitted and payments were still pending.

Pratt described budget and staffing figures shown in the presentation: a reported allocation of 165 positions with approximately 13.4 vacancies and, for the 2025–26 budget, a proposed 181 full‑time equivalents focused on jail health operations. She cautioned that because correctional health historically could not bill Medicaid, design and training for registration, claims and care transitions required extensive work.

Commissioners asked questions about quality oversight, external review options, accreditation, the impact of federal and state Medicaid changes on jail programs (including CalAIM waivers), and how the jail links short‑stay patients to community treatment. Pratt and DPH staff emphasized the importance of pipeline hiring (students, residents, social work trainees) and partnerships across DPH and community organizations to sustain care and staffing.

No formal commission action was taken on the report; commissioners praised the program and requested future updates on CalAIM billing performance and quality measures.","Chief of Jail Health Services described CalAIM implementation, new billing for Medi‑Cal services, staffing and capacity, and care models that link people leaving custody to community treatment.","actionData","errors"]

Article not found

San Francisco Health Commission hears warning of large federal and state Medicaid cuts, local impacts uncertain

Votes at a glance: Health Commission approves minutes, honors two long‑serving DPH leaders, adopts consent calendar

Public commenter warns commission about cumulative effects of digital surveillance on health

Jail health services outline CalAIM rollout, early billing returns and care strategies