Alameda County supervisors direct county administrator to prepare final budget including up to $19.3M for Alameda Health System; motion passes unanimously

The Alameda County Board of Supervisors voted June 23 to direct the county administrator to prepare a final FY 2026–27 budget that incorporates staff-recommended adjustments and a board letter asking for up to $19.3 million in one-time funds for Alameda Health System (AHS) aimed at preventing approximately 92 proposed layoffs, paying for a performance audit and temporarily extending the county’s partial hospitalization/intensive outpatient (PHP/IOP) behavioral health program.

The vote followed hours of presentations and discussion during a special meeting continued from June 22, in which county staff outlined the proposed $6.7 billion spending plan across all funds and described proposed adjustments and contract extensions affecting community-based organizations and health services. County staff told the board the proposed budget closes an approximately $185 million funding gap while maintaining investments in county priorities.

Why it matters: Supervisors and AHS leadership framed the request as a one-time measure designed to preserve staffing and buy time for a performance audit and feasibility work on behavioral health services while longer-term solutions are developed. Supervisors repeatedly cited state-level changes identified in the transcript as “HR 1” and the resulting pressures on the county’s safety-net health system.

Supervisor Miley, who co-authored the letter with Supervisor Fortunato Bass, said the $19.3 million request is intended to “forestall any reduction in force for these 92 workers for an entire year” and to allow for a measured transition rather than immediate layoffs. The co-authors asked staff to identify one-time funding sources other than Measure W and to report back on major procurement and audit milestones.

AHS CEO James Jackson told the board the health system does not plan to “use any of the NNB to close our budget gap” and described the board-requested runway as a way to pursue attrition and voluntary separation programs to change the organization’s cost structure with less impact on staff: “we do believe that to change our cost structure in a significant way, we’ve got to have less FTEs,” he said while also pledging to pursue efficiency measures.

Labor voices urged support. SEIU chapter president Maria Betcourt told supervisors she supports the ad hoc committee’s recommendations and asked the county to back efforts to reduce impacts to workers and preserve services: “we call on the leadership of the county to help support much needed health care services for Alameda County residents,” she said.

County staff and AHS estimated timing for the proposed performance audit and PHP/IOP review: roughly three months to complete procurement and about six months for the evaluation, meaning an approximate nine-month timeline if the board’s direction is approved.

What the board directed: The motion approved at the meeting asked the county administrator to return a final budget for adoption on Thursday that (a) incorporates the county administrator’s proposed budget and no-net-cost technical adjustments, (b) includes the Miley/Fortunato Bass board letter with clarifications requiring periodic updates, procurement milestones and a report-back on audit outcomes, and (c) extends ad hoc monitoring and oversight with a commitment to provide a status update by year-end. Supervisor Tam moved the direction and Supervisor Miley seconded; the motion passed on a unanimous roll call.

Key numbers and timing: Staff presented a proposed total budget of approximately $6.7 billion, a general fund of about $4.3 billion, and more than 10,400 full‑time equivalent positions. The AHS request asks for up to $19,300,000 in one-time funds, which supervisors estimated would cover preserving roughly 92 positions for a year and leave a smaller remainder to support the PHP/IOP extension and performance audit. Staff said some community-based contracts will be extended temporarily and provided RFP award dates for others; staff also noted approximately $30 million in reported efficiency gains at AHS to date.

Next steps: The board recessed and set a special meeting for final budget adoption on Thursday at 4 p.m. The county administrator was asked to post the memos and provide milestone updates when procurement for the audit is complete and again when the study is finished.

Quotes used in this report are drawn directly from the meeting transcript and are attributed to speakers who spoke on the record at the June 23 session.