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San Francisco Department of Public Health presents $2.6 billion budget emphasizing COVID response, behavioral health and racial equity
Summary
DPH told the Budget & Appropriations Committee its $2.6 billion base budget for FY2021–23 will prioritize COVID-19 infrastructure, expanded behavioral-health services (including Mental Health SF) and implementation of a Racial Equity Action Plan while relying on federal/state drawdowns and anticipated CalAIM changes.
The San Francisco Department of Public Health (DPH) presented a two-year budget to the Board of Supervisors Budget & Appropriations Committee on March 10, outlining a $2.6 billion base budget for FY2021–22 and FY2022–23 and highlighting continued COVID-19 response, investments in behavioral health and steps to advance racial equity.
Director Colfax told the committee that DPH’s “mission ... is to protect and promote the health and well-being of all San Franciscans,” and said the department remains focused on sustaining a COVID-19 response while developing longer-term programs. Colfax noted major expenditure areas include operations of Zuckerberg San Francisco General (budgeted at over $1 billion) and Laguna Honda Hospital as significant cost centers, and that salaries and benefits represent just over half of departmental spending. The department reported roughly 7,163 full‑time equivalents across its system of care.
DPH described a mixed-revenue approach that relies on federal and state funding—particularly Medicaid—and on one-time adjustments to meet general‑fund targets. Acting CFO Jenny Louie told the committee the budget includes known Medi‑Cal-related changes tied to California’s CalAIM initiative that the department currently estimates could yield about $24 million in the first year and $15 million in the second year of the two‑year plan. Louie also said DPH released approximately $51.6 million of deferred revenues after Congress delayed a scheduled federal reduction, and expects other one‑time reconciliations for behavioral‑health funding.
Colfax and DPH staff described the department as an “integrated” organization combining the San Francisco Health Network (hospitals, behavioral health and primary care) with population health functions (disease control, environmental health and community programs). That structure, they said, helped the city’s pandemic response by aligning service delivery and public‑health prevention activities.
On behavioral health, DPH emphasized continued rollout of Mental Health SF including bed expansion, permanent supportive housing, sobering and drug‑treatment facilities, and expanded stakeholder processes. The department also flagged a reallocation of $15 million to mental‑health and community reinvestment activities funded from public‑safety dollars.
Supervisors pressed DPH for more detail on implementation and expenditures. Supervisor Ronan asked for a line‑item accounting of Mental Health SF spending and how unspent funds would be treated; DPH said some funds are held in special funds (for example, Prop C) and will carry forward where appropriate. Chair Haney pressed DPH for a stronger, built‑out plan addressing the city’s surge in overdose deaths; Colfax and behavioral‑health leaders said they will return with specific, evidence‑based proposals tied to measurable outcomes.
DPH also outlined equity work tied to the citywide Racial Equity Action Plan, saying funds would support workforce training, hiring and data tracking. Staff acknowledged gaps in managerial and clinical staff diversity and described ongoing efforts to standardize hiring, train managers and partner with pipeline programs, while using community‑based organizations as interim capacity.
On contracting and oversight, Chief Operating Officer Greg Wagner described changes made after controller and city attorney recommendations, including updated MOUs with foundations, donor reporting on sfdph.org, strengthened internal controls, and audits and training to improve compliance.
Colfax and staff said vaccine‑distribution efforts are focused on neighborhoods with the greatest burden of COVID‑19 and that the department is expanding neighborhood and mobile sites to reach underserved communities; they reiterated the primary constraint is vaccine supply rather than local distribution capacity.
No members of the public called to speak on Item 1. Chair Haney moved to file the hearing; the motion was seconded and approved on a 5–0 roll‑call vote. DPH committed to returning to the committee with line‑item details and more specific proposals on overdose prevention, behavioral health implementation and workforce equity.
