Metro Health flags grant “fiscal cliff,” proposes fee changes under new state law

Dr. Claude Jacob, director of Metro Health, presented the department’s FY2026 budget overview and program priorities to the City Council budget work session on Aug. 26, describing both continued public‑health investments and fiscal vulnerabilities tied to shifting grant support.

Jacob said the department seeks approximately $79.2 million for FY2026 with an authorized staffing complement of about 593 positions; the city’s General Fund contribution was presented at roughly $46.5 million with nearly $33 million in grant support. He noted that grants now support a substantial share of department operations and warned that the impending end of Medicaid 1115 waiver reserves in September 2026 — roughly $7.8 million in support this year — creates a “fiscal cliff” that will affect programs and more than 80 grant‑supported staff.

Why this matters: Metro Health runs regional clinical and public‑health services — immunizations, WIC clinics, food‑safety inspections, the Metro Health laboratory, violence prevention and school‑based mental‑health contracts — that are in part grant‑funded. Reductions in grant support could disrupt ongoing programs and require council choices about what the city should…