Healthy Neighborhoods faces steep cuts as Medicaid waiver funding lapses, presenters warn

San Antonio Metro Health officials told the Community Health Committee on Dec. 2 that the department’s Healthy Neighborhoods program — which embeds community health workers in neighborhoods, operates teaching gardens and runs the Via Coronado resource center — faces substantial funding and staffing reductions if a key Medicaid 1115 waiver ends.

The program’s assistant director, Marjorie White, said Healthy Neighborhoods currently employs about 18 community health workers who serve 12 neighborhoods and operate teaching gardens and partnerships such as a healthy corner-store initiative that recorded 19,127 Double Up Food Bucks transactions. Dr. Claude Jacob, speaking for Metro Health, warned that the department expects the loss of approximately $8,000,000 and about 80 staff citywide by Sept. 30, 2026, if the waiver funding is not replaced.

Metro Health officials and public commenters stressed the program’s community-based approach and direct results. Raymond Bryant of the San Antonio Million Garden Project told the committee Healthy Neighborhoods helps residents "learn how to grow food, learn how to prepare food, learn how to eat healthy food and learn how to lead healthier lives." Susie Schumann of United Way of San Antonio and Bexar County described longstanding partnerships with Metro Health and pointed to the 211 helpline as part of a local safety net.

Metro Health described program structure and recent outcomes. White said Healthy Neighborhoods is built on community connectors, a REACH grant focus on policy-systems change and a resource center at Via Coronado that now serves around 300 unique individuals per month. Reported annual outcomes included 1,087 children enrolled in centers applying best-practice health promotion, 17,160 residents served through enhanced food pantries, more than 50 corner stores recognized for stocking fresh produce and 1,240 unique persons served at Via Coronado with 447 health education classes offered.

Officials provided projected budget scenarios: the Healthy Neighborhoods budget would fall from about $2,100,000 to roughly $1,300,000 — about a 36% reduction — and staffing would decline from 23 to 16 positions for the program specifically, Metro Health said. The department estimated program capacity could decline by approximately 35–50% and noted that leadership roles and institutional knowledge would be among the hardest-hit positions.

Committee members pressed Metro Health for priorities to protect and for neighborhood-level and demographic breakdowns to better quantify community impacts. Councilmembers asked how neighborhoods were selected, whether expansion is possible if new funding is found, and whether partners could pick up some services. Metro Health said initial neighborhood selection targeted historically disinvested areas with poor health outcomes and that expansion is contingent on new funding; officials said they are conducting strategic planning to identify partner roles and to preserve core program elements where possible.

Councilmembers and presenters also discussed program evaluation and measurement. Anna McNack, a program manager, said the department uses a mix of qualitative and quantitative methods — stories, videos, surveys and a social-network analysis — and views the Via Coronado resource center as a tool to better track long-term outcomes.

What’s next: Metro Health said it has placeholders in FY27 budget planning and is analyzing scenarios to preserve core functions. Committee members requested additional documentation: neighborhood-specific program breakdowns, demographic data on who is served, and more detailed expenditure and administrative breakdowns so council offices can consider options to maintain services or identify partner agencies that could assume responsibilities.

The committee did not take a formal vote on program changes; Metro Health will continue budget analysis and provide follow-up materials to the committee.