Measure A oversight committee says county used funds in line with ordinance, urges a reserve

Rebecca Rosen, former chair of the Measure A Citizens Oversight Committee and regional vice president at the Hospital Council of the East Bay, presented the committee’s FY 2021–22 review to the Alameda County Board of Supervisors Health Committee and said the committee found recipient spending conformed to the Measure A ordinance. “We found that Alameda Health System and the other recipients of the sales tax revenue spent the funds in compliance with the provisions of Measure A,” Rosen said.

The committee reported that the board allocated about $182,300,000 in Measure A funds for the reporting period. By ordinance, 75% of Measure A revenues flow to Alameda Health System (approximately $143.6 million); the remaining 25% (about $38.7 million) was allocated by the Board to 87 other providers that together reported more than 330,000 patient encounters. Rosen said recipients reported leveraging roughly $239 million from other sources to expand services.

Why it matters: Measure A is a local sales-tax–based funding source established to support emergency, inpatient, outpatient, public-health and behavioral-health services for vulnerable Alameda County residents. The oversight committee’s finding and its recommendation that the county adopt a policy ensuring an adequate reserve speak to how the county plans for year-to-year sales-tax volatility.

The presentation summarized service impacts across care settings: Alameda Health System reported serving more than 125,000 residents; hospitals such as UCSF Benioff Children’s Hospital Oakland and St. Rose cited school-based clinic encounters and faster emergency-to-admission times; behavioral-health funding supported detox and jail-based mental-health assessments and faster connections to substance-use treatment; primary-care and community organizations reported thousands of outreach and navigation encounters; and public-health grantees delivered food, hearing aids and tens of thousands of meals to seniors and other vulnerable populations.

Rosen also read client-level examples submitted by providers to illustrate individual outcomes from Measure A support.

During questions, board members pressed for clarity about whether meal-delivery efforts predated the pandemic and whether particular district allocations (for example, Spectrum Community Services delivering nutritious meals in Supervisorial District 2) represented new work; county staff clarified that Measure A funding commonly supplements existing social-services contracts and that supervisorial offices receive district-specific Measure A allocations. Kristel Ocasio, Alameda County Health financial services director, said fiscal 2021–22 was an unusual sales-tax year with a spike and that staff are assessing year‑over‑year deviations and will present more detail in the Measure A reauthorization discussion.

A board member asked if Measure A offsets Alameda Health System’s operating deficit after public reporting of a roughly $100 million shortfall. County health staff responded that Measure A represents a relatively small portion of AHS’s overall budget (the presenters referenced an approximately $1.5 billion annual operating budget) and emphasized that the oversight committee’s charge is limited to confirming that Measure A funds were used consistent with the ordinance.

The committee’s single formal recommendation was that the county adopt and maintain a reserve policy so base funding allocations can be sustained if future sales-tax revenues fall short. The oversight committee noted it is completing the FY 2022–23 report and expects to make that available next year.

The Health Committee did not take formal action on the recommendation during this meeting; the item was informational and will be part of ongoing budget and reauthorization discussions.