SFHSS CFO warns trust balance may decline; mayor's 15% budget instruction to complicate planning

Iftikhar Hussain, SFHSS chief financial officer, told the Health Service Board that higher‑than‑usual claim activity in September and October is projecting a decline in the health‑service trust balance even though last year’s stabilization planning produced a $5,000,000 increase in the fund.

"We are seeing a decline in the trust balance due to high claim activity," Hussain said, adding that early November indicators show some easing. He said pharmacy rebates are currently estimated at $16,000,000, with actual receipts likely higher in the last quarter of the fiscal year.

Board members pressed staff on a reported decrease in the sustainability fund; Hussain and other staff explained that certain well‑being activities were moved into the trust after the mayor's office declined to fund them from the general fund. "Hopefully, that's just a one‑year decision," Hussain said, and staff plan to re‑raise the issue as part of next year’s budget process.

Hussain said SFHSS will present an audit plan at the board’s January meeting covering recent audit results and planned 2025 work. Separately, Executive Director Abby Yant warned that the mayor’s budget instructions — a roughly 15% cut asked of departments — will be a challenge for SFHSS as the department prepares its budget recommendations.

Board members also raised questions about member call wait times during open enrollment; staff acknowledged temporary voicemail practices and said an off‑site call center partner (VSA) remained staffed to support members while SFHSS handled high back‑office workload.

No formal board action was taken on the financial report; staff will return with audit details and rate/assessment considerations in upcoming meetings.