San Francisco jail health director outlines services, CalAIM billing and reentry challenges

Dr. Lisa Pratt, director of Jail Health Services at the San Francisco Department of Public Health, told the Sheriff’s Department Oversight Board on an itemized presentation that jail health provides comprehensive, 24/7 medical and behavioral care for people booked into city jails and is beginning to bill Medi‑Cal through California’s CalAIM justice‑involved initiative.

Pratt said San Francisco jail health treats conditions often unseen outside jail, ranging from emergency stabilization to long‑term medication management, and works in partnership with the San Francisco Sheriff’s Department and San Francisco General Hospital. “We expect that our people in San Francisco, the residents of San Francisco who end up in jail, should have the same access to good care that they get at Castro Mission or, at Tom Waddell or wherever… and that care shouldn’t have a signal drop when they enter the jail,” Pratt said.

The presentation laid out why the Department of Public Health (DPH) operates jail health services, the clinical flow from booking through stabilization at CJ2 and longer‑term programming at CJ3, and the program’s resources and limits. Pratt said jail health is a relatively small slice of DPH’s budget but serves a large, high‑need population: “Jail health is 1% of the DPH budget,” she said, while serving about 1,300 people on any given day and handling more than 14,500 admissions per year.

Why it matters: Pratt described both clinical capabilities and operational constraints that affect public health and reentry outcomes. CalAIM’s justice‑involved billing is intended to create a revenue stream and set a minimum standard of covered services for incarcerated patients, Pratt said, which could fund more staff and continuity of care after release.

Key points from the presentation

- Scope of care and staffing: Jail Health provides intake screening, primary and urgent care, infection control, mental‑health services, substance‑use treatment and pharmacy services across San Francisco jails. Pratt described nursing as the 24/7 backbone of the service and noted pharmacy expansion to provide 30‑day medication supplies on release. She said the program’s annual budget is about $45,000,000 and includes roughly 165 full‑time equivalents.

- CalAIM and billing: Pratt described CalAIM (the California Medicaid initiative that includes a justice‑involved component, built on a federal 1115 waiver framework) as the mechanism now allowing jail health to bill Medi‑Cal for services that previously were 100% general‑fund supported. Pratt said the department conservatively projects roughly $17,000,000 in CalAIM revenue in the near term but emphasized collection depends on staffing and implementation capacity.

- Behavioral health and substance‑use care: Jail Health offers medication for opioid use disorder (including buprenorphine and methadone) and reported about 400 patients per day on medication for opioid use disorder. Pratt said all people booked are screened for substance use and that medication‑assisted treatment and “direct to inject” options can offer protection for people who might be detained only briefly.

- Infection control and public‑health risks: Pratt highlighted infection control for TB, HIV, hepatitis C and sexually transmitted infections, noting point‑of‑care testing shortens time to treatment. She warned that TB detection is difficult because testing is voluntary and jail churn complicates contact tracing: “If there's a TB outbreak, it will be almost impossible to do contact tracing because of jail,” Pratt said.

- Operational limits and access: Pratt said jail health cannot control housing placement or patient movement within the jail and cannot refuse bookings when detainees arrive; the service must operate continuously and coordinate with the sheriff for transfers to hospitals. She described limitations on confidential clinical encounters when deputy staffing drops after certain shifts and said some patients are seen at cell front rather than in private exam rooms when staffing is constrained.

Board discussion and concerns

Board members thanked Pratt for the presentation and raised operational and strategic questions. Member Carryon commended the clinical tone and asked whether CalAIM metrics will be used to evaluate what’s working; Pratt said implementation is just beginning and that the program is setting up metrics such as monthly Medi‑Cal eligibility and enrollment for justice‑involved patients.

Member Palmer and others described personal observations of street conditions and mass arrests and asked how such operations affect jail health resources; Pratt said large booking events can overwhelm intake and increase overdose risk if staff cannot triage effectively. Member Palmer and others also emphasized partnering with formerly incarcerated people and community‑based organizations for outreach and education.

Several members pressed Pratt on language access and safety: Pratt said the jail uses interpreter lines and has “threshold” language capacity but lacks sufficient language‑competent clinical staff for many detainees’ primary languages.

About maternal care and restraints, Pratt said the use of restraints on pregnant patients would violate law and that the department works with the sheriff’s office and hospital clinicians to prevent illegal shackling during transport or labor.

Formal board action

The only formal motion on the agenda before Pratt’s presentation — approval of the March 7 and May 9, 2025 meeting minutes — was moved and approved by roll call. The board recorded five ayes; the minutes were approved.

Ending: Pratt asked the board for a “wish list” of priorities to support budget requests and reiterated that while jail is not the ideal place to receive health care, it is for many people their point of access. She said CalAIM offers an opportunity to fund reentry linkage and to expand services if the city invests in staffing and program capacity.

Votes at a glance

- Approval of meeting minutes (03/07/2025 and 05/09/2025): Approved by roll call, 5 ayes, 0 no, 0 abstain. (See actions array for details.)

Source: Presentation and Q&A recorded on the Sheriff’s Department Oversight Board meeting transcript; direct quotes and data points are taken from the transcript of Dr. Lisa Pratt’s presentation and members’ remarks.