Community groups and clinicians urge board to reject DPH contract cuts and clinic closures

San Francisco’s Board of Supervisors heard hours of public testimony June 16 on proposed Department of Public Health budget reductions that DPH officials say are driven largely by cuts in federal and state Medicaid funding.

DPH Director Dan Tsai told the board the city is facing “several $100,000,000” in lost federal and state revenue tied to changes in Medi‑Cal and related programs and described the mayor’s budget direction to increase local general‑fund support for DPH to preserve core safety‑net services. "That alone is a substantial portion of the entire city's budget deficit," Tsai said, explaining the department identified roughly $19.9 million in Community Based Organization (CBO) contract reductions and other line items that could lead to reductions in services.

A central topic at the hearing was a set of proposed clinic consolidations and contract reductions the department identified as requiring a Beilenson (statutory) hearing because they may result in reduced medical services. Tsai said DPH tried to limit layoffs by eliminating vacancies and reassigning staff, and that of roughly 130 FTE positions identified in the budget, only two layoffs remained as of his presentation. He acknowledged the cuts’ impact on vulnerable populations and emphasized the department’s goal to "do the least harm possible."

Public comment filled the chamber. Workers, clinicians and leaders from unions and community organizations described specific services at risk and urged the board to reject the cuts or restore funding. Common themes included:

- Southeast Mission Geriatric Clinic: multiple speakers said the clinic provides the city’s last outpatient geriatric psychiatric specialty care and warned that its closure would leave older adults without an equivalent outpatient option. A clinician said Medicare accounts for about 80% of the clinic’s billing and challenged reported utilization figures as inaccurate because of Epic reporting gaps.

- Youth clinics (Huckleberry and Larkin Street/Chippie clinics): clinicians, youth advocates and providers said these integrated clinics offer low‑barrier, specialized medical and mental‑health care for transitional‑age and LGBTQ youth and that closing them would break trust and lead many young people to stop seeking care.

- HIV prevention and harm‑reduction services: organizations including the San Francisco AIDS Foundation, harm‑reduction providers and long‑term HIV survivors described deep worry that reductions will reverse progress on prevention and care, increase emergency‑system costs and worsen outcomes for marginalized groups.

Union representatives (SEIU 1021 and others) and clinicians also raised staffing and data‑reporting concerns and said the department had not provided credible transition plans demonstrating where patients would be redirected if clinics close.

Several speakers recommended alternative fiscal approaches, including using the city’s risk/reserve funds or pursuing other local revenue options rather than cutting frontline services. The board held the public record open for statutory consideration; no final board action on the budget reductions was taken at the hearing stage.

Why it matters: Speakers argued the proposed reductions would cut low‑barrier and culturally specific services for seniors, youth, people living with HIV, and people who use drugs—populations that providers said are least able to absorb loss of trusted care relationships.

What’s next: The Billinson hearing is a required step before the board may approve reductions that reduce medical services; supervisors will consider public testimony as the mayor’s office and DPH work through implementation details and next budget steps.