San Francisco holds legally required public hearing after mayor's budget proposes millions in public health cuts

The San Francisco Board of Supervisors convened a state-mandated public hearing June 25 on proposed reductions to the Department of Public Health budget, hearing hours of testimony from DPH leaders, supervisors and community-based organizations about potential impacts on behavioral health, violence-intervention services, oral health and food-access programs.

DPH Director Grant Colfax told the board the hearing was being held "pursuant to California Health and Safety Code section 1442.5" and outlined a set of draft reductions the department is required to present before final decisions. "Should these reductions remain in the budget, we will do all we can to work with CBOs and mitigate impacts of these reductions," Colfax said.

The most significant proposal described by DPH staff is a second-year, 5% across-the-board cut to contracts with community-based organizations (CBOs) for services that do not leverage state or federal matching funds; DPH estimated the reduction would total about $10 million and said behavioral health services would represent roughly $7.3 million of that figure. Jenny Louie, DPH chief operating officer, said the city would spend the year developing an implementation plan and assessing client impact before any cuts take effect.

DPH also described a $2.7 million proposed reduction tied to the sugary drink distributors tax-funded programs, which DPH said would leave about $3.0 million remaining in the department for some existing initiatives. The presentation lists nearly $1.8 million cut from Healthy Communities and Policy/Systems grants and elimination of a one-time $350,000 Healthy Community Supports line. DPH indicated those dollars are proposed to shift to the Human Services Agency for food-security work.

Separately, DPH presented a proposed $2.5 million reduction to the Street Violence Intervention Program (SVIP). DPH staff said $2.1 million of that amount represented funding previously advanced by the Department of Children, Youth and Their Families (DCYF) that DCYF plans to reallocate to school-based crisis intervention; DPH said the remainder would be subject to a reprocurement process.

DPH officials said oral-health task force grants across the city, currently funded at about $450,000, would be eliminated under the mayor's proposal, though they said some direct dental services would remain through primary-care programs and Medi-Cal billing.

Supervisors pressed DPH on timing, impacts and community outreach. Supervisor Aaron Peskin's chairing of the meeting echoed that the proposed cuts are mainly in fiscal year 2025-26; Supervisor Safaie told Colfax "we're in an overdose crisis in our city" and urged the department to spare services tied to overdose prevention. Supervisor Preston and others questioned DPH and the mayor's office about the soda-tax shift and about whether the community engaged before staff-level decisions were finalized.

The hearing drew more than three hours of public comment from dozens of nonprofit leaders and program staff. Representatives from Glide, Tenderloin Neighborhood Development Corporation, Community Forward SF, Larkin Street Youth Services, CARE/SN and multiple smaller cultural- and neighborhood-based groups said the targeted lines proposed for cuts fund essential outreach, culturally and linguistically appropriate services and prevention work that cannot be replicated by simply moving money between departments.

Speakers warned cuts would worsen outcomes and increase costs elsewhere in the system. "Direct services without effective outreach are like a storefront with no signs, no lights on, and no marketing. They will remain invisible to those that need them the most," said Gabriela Castellanos of CARESN, describing oral-health outreach work in Chinatown and the Mission. Several commentors asked the board to tap opioid-settlement funds and other nonrecurring sources before reducing general-fund supports for behavioral health.

DPH acknowledged the administration proposed the reductions as part of the mayor's budget process; staff said the department will work with community partners over the coming year to refine implementation plans and mitigate harms if the cuts remain.

No final votes were taken at the hearing. The board closed the public testimony portion after hearing from the DPH team and dozens of speakers, and supervisors signaled they would continue to examine the proposed reductions through the budget and appropriations committee process.

Why this matters: The proposed reductions would affect services that city staff said are not eligible for state or federal matching funds and therefore are easier targets for short-term savings. DPH's presentation counts behavioral-health and community-outreach contracts as among the largest line items affected. Community groups told supervisors the reductions would reduce culturally competent outreach and prevention, likely increasing downstream use of costly emergency care.

What happens next: The Bielen-son hearing satisfies the state requirement that counties hold a public hearing before reducing medical services. The details of any final cuts will be decided in the city's budget process and in committee, where supervisors said they will seek more data on client impacts and options to restore funding.

Ending note: DPH leaders repeatedly noted many proposed cuts would take effect in the fiscal year beginning July 1, 2025, and that the department intends to produce a mitigation plan for affected contract partners and communities if reductions are finalized.