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Alameda County health director warns Medi‑Cal and braided federal funding are vulnerable to federal policy shifts
Summary
Interim Alameda County Health Director Anika Choudhry told supervisors the county’s safety net relies heavily on Medi‑Cal, federal grants and pass‑through funds and flagged CalAIM and Medicaid as high‑risk areas if federal guidance or appropriations change, urging coordinated county messaging and protective measures.
Alameda County’s interim health director, Anika Choudhry, warned the committee that county health and safety‑net programs are tightly braided with state and federal funding and therefore vulnerable to changes at the federal level.
Choudhry told the ad hoc committee that approximately half of the Health Agency’s budget for FY 2024–25 comes from state and federal sources and that nearly 1,000,000 county residents are enrolled in Medi‑Cal. She identified CalAIM — California’s Medicaid waiver program — as a particular exposure point because it supports housing and social services that many providers and recipients rely on.
"Because we braid so many different types of funding together, sometimes it's hard to figure out which is which," Choudhry said, noting that reductions or policy shifts at the federal level could force Medi‑Cal plans to scale back optional services such as housing supports or food assistance.
Choudhry also highlighted public‑health monitoring responsibilities (about 180 communicable diseases monitored by public health) and behavioral‑health and homelessness caseloads — items she said could be affected if federal grants change. She urged the county to coordinate communications so residents do not disenroll from Medi‑Cal out of fear of data sharing and encouraged state protections for data privacy.
Supervisors asked about practical steps to limit disenrollment and asked health staff to coordinate messaging and consider relaunching trusted‑messenger networks previously used during the pandemic.
(Reporting note: figures and program names are attributable to the county health director's presentation to the ad hoc committee.)
