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Metro Health warns of deep cuts to diabetes prevention as Medicaid waiver reserve wanes
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Summary
Metro Health staff told the City Council committee that reserves tied to a Medicaid waiver are shrinking and that the diabetes-prevention program faces a possible 72% cut in FY27, which would reduce staff and the number of community workshops.
Metro Health officials told a San Antonio City Council committee on Oct. 23 that budget reductions and declining Medicaid-waiver reserves threaten programs that deliver preventive care in neighborhoods, with one diabetes-prevention program facing a possible 72% reduction in FY27.
Margery White (Metro Health) presented an overview of the department’s portfolio and funding structure, noting the department’s adopted FY2026 budget and that Medicaid-waiver reserves that supported expanded services have declined. “Somos un departamento de salud acreditado nacionalmente… y tenemos los marcos de trabajo que codificamos nuestros departamentos,” White said, describing the department’s effort to sustain services after pandemic-era funding shifts.
A subsequent presentation on diabetes prevention said the city’s diabetes-prevention team runs roughly 60 workshops a year with a 12-person team and that in FY25 the program provided 65 workshops and registered 562 community members. The program coordinates more than 500 clinics and helped 1,445 individuals with medication access, delivering 3,102 prescriptions at a total of about $200,000 (average per-dispensed medication cited as $64.47).
Metro Health staff said the diabetes program’s FY26 budget was about $1.6 million and that, under current scenarios, the FY27 allocation could fall to about $465,000. Staff said that would reduce the team by approximately three specialists and substantially cut the number of community workshops offered.
Nut graf: Metro Health asked the committee to note the fiscal fragility caused by declining waiver reserves and to pursue collaborative options — including county and university partnerships and grant applications — to maintain preventive services. The presentation was informational; committee members discussed coordination but no funding decision was made Oct. 23.
Councilmembers raised coordination with Bexar County and universities and asked staff to explore shared-service models. Councilmember White asked whether the department’s funding picture was a snapshot or part of a larger planning process; staff said the presentation was an overview and that multiple scenarios are under consideration. Councilmembers repeatedly emphasized the importance of preserving prevention and clinic capacity amid tight city budgets.
Ending: Metro Health said the waiver-funded reserve that helped expand services will run out and that staff will return with options; no budget vote was taken during the Oct. 23 session.
