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DAS director warns federal Medicaid changes could increase local demand; state budget preserves HomeSafe funding
Summary
Executive Director Kelly Dearman told the DAS commission that pending federal Medicaid changes and the state's 2025 budget will affect San Francisco older adults and vulnerable residents; the state budget preserved an $83.8 million HomeSafe allocation but local budgets remain tight.
SAN FRANCISCO — Kelly Dearman, executive director of the San Francisco Department of Disability and Aging Services (DAS), told the commission on July 2 that national and state budget developments could significantly affect older adults and adults with disabilities in the city.
Dearman said a large federal bill that passed the Senate and was headed back to the U.S. House could lead to changes in Medicaid (Medi‑Cal) enrollment rules and work requirements that she said “could mean 11,000,000 people could lose coverage” under the current draft language. She cautioned that the commission does not yet know local numbers but said the change to a six‑month reenrollment cycle and work requirements could produce administrative churn and more people seeking local services.
Why it matters: Loss of coverage or more frequent reenrollment could increase demand for local safety‑net services, from food assistance to conservatorship and case management.
State budget and HomeSafe
Dearman said California’s 2025 state budget, signed by Governor Gavin Newsom on June 27, reduced an earlier proposed immigration‑related premium and set higher asset limits for eligibility (she reported $130,000 for individuals and $195,000 for couples). She also said the HomeSafe program — a state program that helps vulnerable people stay housed — was not ended and that the budget includes $83,800,000 that will be distributed across counties. Dearman said allocation to San Francisco is not yet known and DAS has no finalized spending plan for that funding.
Local budget pressures
Dearman described the local budget process as “brutal” and said DAS presented to the city's Budget and Appropriations Committee; the department's requested budget was unanimously approved internally and now proceeds to the Board of Supervisors and mayor for final adoption. She said staff positions were preserved but some vacant positions were cut and that the food budget is effectively flat, which DAS interprets as a cut given high inflation for food.
Conservatorship and beds
Dearman summarized recent hearings about conservatorship and said San Francisco is piloting a shelter‑bed reservation and wraparound‑services model intended to allow more rapid temporary conservatorships when appropriate. She said the conservatorship program is “complicated” and an “intervention of last resort,” and that the department is coordinating with the Department of Public Health to expand beds at varying levels of care.
Direct quotes and context
"What this means, the realistic bottom line, is that people will just roll off because the restrictions will be really hard for people to keep up with," Dearman said of the draft federal changes. She added that state funding wins for HomeSafe represent “a big victory for older adults and vulnerable community members who rely on it to stay housed and supported.”
Next steps
Dearman said DAS will monitor federal developments and report back to the commission as local impacts become clearer. She also encouraged commissioners to continue outreach to congressional offices on federal proposals.
