Board votes to begin transition toward single county Medi‑Cal plan, changes Family Health Plan governance

The Santa Clara County Board of Supervisors voted unanimously on May 20 to direct county staff to begin a multi‑step process to transition toward a single county‑owned Medi‑Cal managed care plan and to change the Santa Clara County Health Authority’s governance structure.

Why it matters: County leaders said the move is aimed at protecting the county’s safety‑net hospitals, clinics and community providers from looming state and federal changes to Medicaid funding and to reduce administrative fragmentation they said is limiting the county’s ability to maximize reimbursement for patient care.

The board’s action followed a lengthy staff briefing and more than two hours of public comment from physicians, clinic and hospital executives, union representatives, and community leaders. County Executive James Williams framed the proposal as a structural response to a shifting federal and state policy landscape that may reduce Medicaid-related revenues and enrollment. Williams told the board the current multiple‑plan structure creates administrative inefficiencies and leaves county providers exposed to revenue shortfalls.

The package approved by supervisors includes a set of near‑term governance changes to the Santa Clara County Health Authority (also known as Santa Clara Family Health Plan, or FHP) and direction for county staff to pursue state regulatory approvals needed to establish a “single plan” model in which a unified, county‑operated plan would coordinate Medi‑Cal services and rate advocacy across the local safety‑net.

President Lee, who moved the motion, said the action is not intended to change beneficiaries’ coverage, provider networks, or current contracts, and emphasized the board’s intent to center patients and community providers. “There is nothing in the actions in front of the board that would change anyone’s Medi‑Cal benefits or any payments that beneficiaries make,” Lee said during the meeting. The board accepted a friendly amendment to add three interim seats to the temporary governing board drawn from names recommended by the current FHP board to preserve institutional knowledge and community voice while the transition proceeds.

Supporters at the meeting included hospital physicians and hospital leadership who said current plan fragmentation creates delays and denials for specialists, elective procedures and medications. “This model is confusing to our providers and our patients, and it has created unintended barriers to care,” said Dr. Dolly Goyle, who described clinical leadership roles spanning the county system. Labor representatives for county health plan employees also supported the board’s action, saying a unified model would bolster the county safety net in the face of federal and state changes.

Opponents urged more public process and engagement before making sweeping governance changes. Christine Tomkala, chief executive of Santa Clara Family Health Plan, urged more collaboration and warned that the proposal risked undermining trust and community input if carried out precipitously. Several resident advisory members and community organizations asked the board to delay action and preserve community representation on any new board.

Vote and next steps: The board voted 5–0 to approve the staff recommendations. The motion calls on administration to begin the multi‑stage process (including county code changes and state regulatory work) required to create a single, county‑owned Medi‑Cal plan and to establish a temporary governing board and a transitional advisory committee. The county said no immediate changes will be made to beneficiaries’ coverage, provider networks or existing contracts; any consolidation will follow state approvals and a deliberate implementation process. The board also directed administration to engage community stakeholders and to return with milestones and updates as the transition proceeds.

Ending: Supervisors said they will keep the process public and asked staff to bring regular updates as regulatory steps and technical analyses proceed. The board emphasized that its priority is sustaining access to care for Medi‑Cal beneficiaries and stabilizing revenue flows to the county’s hospitals and safety‑net clinics.