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Alameda County Health lays out FY26–27 MOE: behavioral health drives majority of agency budget
Summary
Alameda County Health Director Anika Chowdhury presented a $1.369B MOE appropriation and $1.166B in revenue, with behavioral health accounting for roughly 60% of the agency’s budget; she highlighted investments in housing/homelessness coordination, HealthPAC, EPIC EHR and behavioral health bridge housing while warning of cost shifts from Prop 1 and HR1.
Anika Chowdhury, Alameda County’s Health Care Services director, told the Board of Supervisors on April 14 that the department’s FY26–27 preliminary maintenance‑of‑effort budget will propose about $1.369 billion in appropriations and roughly $1.166 billion in revenue. She said the appropriation represents a modest year‑over‑year increase but that the agency faces major programmatic pressure from rising salary and benefit costs and the loss of one‑time revenues.
Chowdhury said the behavioral health department (ACBHD) represents roughly 60% of the agency’s appropriation — about $815.8 million — and that CBO contracts make up a large share of those funds. Other major components include the Office of the Agency Director (including housing and homelessness services at nearly $80 million) and Public Health (largely grant‑funded). Key Investments highlighted for FY26–27 included:
- $124.75 million to continue countywide coordination of housing and homelessness services (excluding Measure W funding); - $85.3 million to sustain the HealthPAC program that serves low‑income residents not eligible for Medi‑Cal; - Funding for a $50 million forensic behavioral health plan and additional resources to support Care Court implementation and behavioral health bridge housing; - $17.11 million to begin implementation of the EPIC electronic health record across behavioral health, public health and the sheriff’s office; and - $35.83 million for environmental health modernization and facility upgrades.
Chowdhury stressed that federal and state policy changes — notably HR1 proposals and state Medi‑Cal adjustments including Prop 1 implementation — create significant uncertainty and potential cost shifts that could materially affect county responsibilities. She said ACBHD had identified $53 million in program reductions tied to current Prop 1 changes and that potential federal changes to HUD and other grant programs could reduce funding for permanent supportive housing.
Board members asked for additional breakdowns, including the composition of the $138.72 million in contracts with Alameda Health System (AC Health noted that direct IGTs to AHS are separate and would be reported in more detail), and pressed for comparative year‑over‑year numbers for the department’s major revenue categories and FTE counts. Chowdhury said the department would provide more precise figures to the board and noted that many policy impacts will depend on the May revised state budget and ongoing federal rulemaking.
Why it matters: Alameda County Health’s MOE dominates several county budget lines and its policy‑linked risks — care court implementation, Medi‑Cal redefinitions and potential HUD reductions — could require the board to weigh local service preservation against constrained revenues.
