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Date: |
November 17, 2026 |
26 |
Title
Authorizing Supplemental Grants to Address Critical Gaps in Healthcare Access and Hunger Relief (Districts: All)
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Overview
When the County adopted its Fiscal Year 2026-27 budget, the Board anticipated that federal cuts to healthcare and food assistance under H.R.1 would create significant gaps in San Diego County's social safety net. To prepare for these impacts, the Board set aside one-time funding to protect essential services and help meet the growing need for healthcare and hunger relief.
On October 22, 2026, the Ad Hoc Subcommittee on the Social Safety Net and Behavioral Health Systems Transformation (“Subcommittee”) met with community-based organizations that focus on social services referrals, hunger relief, and affordable health care to assess the frontline impacts of H.R. 1 and the regional cross-sector response. Community partners described growing needs outstripping the regionwide resources available to meet them, reinforcing the urgency of deploying the resources the County had already set aside.
CalFresh recipients are down 32,000 from last year and about 1,800 residents lost CalFresh benefits for the first time in October under new H.R. 1 work requirements, pushing residents onto the local hunger relief system. Food providers reported a 20% increase in demand compared to a year ago, with one pantry serving a record 5,000 households in a single month this fall, up from about 500 on average in 2023. With the federal government cutting food assistance programs across the board, the San Diego Food Bank and Feeding San Diego now receive 57% of all food referrals through 211 San Diego, up from 38% a year ago. The County’s Safety Net Bridge Program food distribution events are stepping in to provide meaningful assistance, already distributing nearly 70,000 pounds of food to over 5,000 people, yet demand for hunger relief continues to climb month after month.
Meanwhile, Medi-Cal recipients are down 87,000 from a year ago and over 12,000 San Diegans have already dropped Covered California coverage due in large part to discontinued premium subsidies. Community clinics serving the Medi-Cal population are experiencing mounting losses from uncompensated care while acute care providers are seeing overstretched emergency services. Throughout the summer, emergency department volumes were elevated, in some cases exceeding the 2025 winter flu season. During September and October of this year-months not typically associated with high rates of 911 calls and emergency department visits-there were multiple periods when few or no ambulances were available to respond to record 911 call volume. With Medi-Cal work requirements taking full effect in early 2027, already financially-strained and overstretched providers are preparing for the worst. Additional County action is needed now to protect both the short and long term health of County residents.
Today’s item authorizes supplemental grants to trusted community partners to address critical gaps in low-income healthcare access and hunger relief. These established community partners are on the frontlines in responding to public needs and will use County funding to sustain and scale their efforts to mitigate H.R. 1 impacts.
Body
Recommendation by Chair Terra Lawson-Remer and Vice Chair Monica Montgomery Steppe:
1) Pursuant to California Government Code Section 26227, find that the grant programs authorized in the following recommendations are necessary to meet the social needs of the County’s population in the areas of health and welfare. Authorize the Chief Administrative Officer, or designee, upon successful negotiations, to execute a subrecipient grant agreement or amend existing grant agreements, totaling $6,200,000 for the following organizations:
a. $2,000,000 with Planned Parenthood of the Pacific Southwest over FY26-27 and FY27-28 to preserve access to preventative and primary care services.
b. $1,300,000 with FORWARD to support the United for San Diego Covered California Program.
c. $1,000,000 with Feeding San Diego to expand the capacity and capabilities of their food recovery network, and to execute any subsequent amendments thereto.
d. $1,000,000 with the San Diego Food Bank to support food purchasing and distribution capacity, and to execute any subsequent amendments thereto.
e. $600,000 with Rady Children’s Hospital San Diego’s Healthy Eating, Active Living (HEAL) Program to address pediatric obesity through medical management, psychological support, lifestyle behavioral modifications and nutrition services, including the provision of fresh food boxes to participating families throughout the duration of the two-year program.
f. $300,000 with Champions for Health to expand staff and the capability to connect uninsured adults to no cost medical services, while offsetting costs that would otherwise be passed on to referring providers or community clinics.
2) In accordance with Board Policy A-87, Competitive Procurement, and Administrative Code Section 401, authorize the Director, Department of Purchasing and Contracting to amend contract No. 572127 with the Regents of University of California to add $500,000 to the ¡Más Fresco! Plus program, which supports programs delivering fresh produce to community members experiencing health disparities, including food/nutrition insecurity and diet-related chronic disease, who are often left out of traditional safety-net programs, subject to the availability of funds; and to further amend the contract as required to reflect changes to services, subject to the approval of the Deputy Chief Administration Officer, Health and Human Services Agency.
3) Transfer appropriations of $6,700,000 from Finance Other, Services & Supplies, to the Health and Human Services Agency, Services & Supplies for support of these grant agreements and contract amendment based on available prior year Unrestricted General Fund balance identified as Unlocked Reserves.
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Equity Impact Statement
The proposed action directs supplemental resources to community organizations addressing the hunger and health care needs of residents directly impacted by federal cuts. By investing in food and health care access for the most vulnerable, the County is helping to mitigate disparities in health outcomes and quality of life.
Sustainability Impact Statement
The proposed action supports the County’s sustainability goals in part by investing in food recovery programs that expands access to healthy food and reduces waste by keeping surplus food out of landfills.
Fiscal Impact
Funds for this request are included in Finance Other in the Fiscal Year (FY) 2026-27 Operational Plan. If approved, this request will result in one-time costs of $6.7 million to provide supplemental funding to improve access to low-income health care and hunger relief services. The funding source is a one-time allocation from Unlocked Reserves designated for safety net services. This action reduces the safety net services balance of funds in Finance Other to $18.4 million remaining to be allocated. There will be no additional staff years.
Business Impact Statement
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Advisory Board Statement
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Background
Federal changes under H.R. 1 restrict eligibility for CalFresh and Medi-Cal, and community partners testified to the Subcommittee that unmet needs for food and medical care are growing faster than the resources available to meet them. The number of active CalFresh recipients has reduced by 32,000 since last year. The number of Medi-Cal recipients is already down by 87,000 since last year and will likely see further reductions as work requirements take effect in January 2027. The organizations put forward for grant funding in this item are trusted community partners that already provide services upon which residents rely. County funding will rapidly expand existing offerings and quickly make more assistance available.
Hunger Relief. The San Diego Hunger Coalition estimates that 835,000 San Diegans, including over 200,000 children and nearly 200,000 seniors, cannot afford three healthy meals a day. The County’s monthly meal gap grew 32% between March and June 2026. The Board has responded with a series of investments, including $1 million in the FY 2025-26 second and third quarter budget adjustments to the San Diego Food Bank and Feeding San Diego and $1 million for Safety Net Bridge Program food distribution events. Demand, however, is still outpacing these efforts.
Feeding San Diego serves over 215,000 households each month and partners with over 380 local organizations to distribute over 39 million pounds of food year. About 90% of the food distributed each year is recovered surplus from farms, grocery stores, and other retailers that would have otherwise been discarded. Feeding San Diego coordinates a network of hundreds of trusted community nonprofits, providing food pickup, delivery, compliance support and inventory management. County staff report that 13,736 tons of edible food went to waste in 2023 for lack of funding and infrastructure to recover it. A $1 million grant to Feeding San Diego would fund three additional staff (two drivers and one coordinator) for four years and a refrigerated van sufficient to recover over 500,000 additional pounds of food annually for hungry families.
The San Diego Food Bank serves approximately 400,000 San Diegans each month through more than 500 nonprofit partners and its own direct distributions. The San Diego Food Bank distributed nearly 52 million pounds of food last fiscal year, about half of which was fresh produce. The Food Bank’s partner pantries report that they are already feeling the strain of H.R.1 changes to CalFresh eligibility. Since April 2026, the pantries have distributed about 67% more food monthly. The Food Bank’s Vista pantry served more than 5,000 households in September, up from about 500 per month in 2023. A $1 million grant would go toward food purchasing and distribution capacity in three high impact categories: flexible food purchasing for individuals experiencing homelessness and residents impacted by emergencies, a refrigerated tractor truck to expand rural and isolated community access and facilitate bulk distribution, and an electric delivery truck dedicated to the Backpack 4 Kids program which serves 4,000 students at Title 1 schools across the county.
¡Más Fresco! Plus provides nutrition incentives and access to fresh, locally grown produce for residents experiencing food insecurity. The Board has supported this program since FY 2021-22, recently allowing ¡Más Fresco! Plus to serve 918 households in FY 2024-25 and 400 households in FY 2025-26. By delivering fresh produce directly from San Diego County farms to participating households, ¡Más Fresco! Plus helps close gaps in food access while generating economic opportunities for local farmers. Working through a network of trusted community-based organizations, the ¡Más Fresco! Plus program reaches underserved households, including residents who may not qualify for or participate in federal nutrition assistance programs, such as CalFresh, as well as those who face transportation, mobility, and other barriers to accessing traditional food assistance. A $500,000 additional investment in County Contract 572127 will support ¡Más Fresco! Plus programs that deliver fresh produce to community members experiencing health disparities, including food/nutrition insecurity and diet-related chronic disease.
Low-Income Health Care Access. Low-income people are already at higher risk for many diseases, including heart disease, diabetes, and many cancers. Cuts to Medi-Cal and the addition of work requirements for many eligible participants will only magnify these disparities as people lose access to regular preventative care and the County’s healthcare safety net is stretched to capacity. Cuts to federal grant funding for programs at hospitals and universities also threaten the health programs, clinical trials, and social wraparound services that lower income communities rely on and utilize to break generational cycles of poor health. Providing access to high-quality healthcare services through the social safety net is crucial both for the long-term health outcomes of our communities and the overall stability of County healthcare infrastructure.
Planned Parenthood of the Pacific Southwest operates 10 health centers in San Diego County and served 115,000 patient visits in FY 2025-26. About 70% of FY 2025-26 visits were for patients with Medi-Cal. While testing and treatment for sexually transmitted infections is the most common reason for visits, the centers also regularly provide cancer screenings, contraception consultations, ultrasounds, breast exams, menopause care, and more. Planned Parenthood’s care coordination program connected more than 9,000 patients over two years to mental health services, food, housing, and other support. As a result of H.R. 1, Planned Parenthood reported $2 million in uncompensated care last fiscal year and projects total losses of $2.5 million after Medi-Cal work requirements take effect. This level of uncompensated care jeopardizes the viability of Planned Parenthood’s neighborhood clinics. A $2 million grant ($1 million per year for two years) would help to stabilize the clinics and preserve access to lifesaving preventative and primary care, particularly in communities that lack other affordable care options.
The United For San Diego Covered California Program is a collaborative public-private partnership to protect access to affordable health care by providing a premium credit to low-income legal residents in the San Diego region who will lose the federal Advanced Premium Tax Credit (APTC) on January 1, 2027 under H.R.1. 149,000 San Diego residents are currently enrolled in Covered California and the loss of enhanced premium subsidies has already contributed to 12,200 San Diegans dropping coverage. H.R.1 will eliminate the federal APTC for an additional 3,510 lawfully-present residents in San Diego County, which will lead to forgone preventative and primary care and contribute to acute episodes that strain the region’s overstretched emergency services. The County’s $1.3 million investment in the premium credit program will be matched with $8.7 million from Price Philanthropies and $0.5 million from the Prebys Foundation, and will help approximately 1,800 residents at or below 160% of the Federal Poverty Level maintain coverage through Covered California. The program will be jointly administered by Covered California and FORWARD. FORWARD is an established payments partner that manages over $1.0 billion in funding from government, nonprofits, and foundations, and has been a contractor for Covered California for the last three years. FORWARD’s role is limited to receiving funds and disbursing them to health plans at the direction of Covered California under the terms set by the United for San Diego Covered California Program. All County funds will go directly towards premium assistance for low-income legal residents in San Diego County and will not be used to support any overhead or administrative expenses.
Rady Children’s Hospital San Diego’s Healthy Eating, Active Living (HEAL) Program addresses pediatric obesity through coordinated medical management, psychological supports, lifestyle behavior modification work, and nutrition support, including the provision of healthy food boxes for participants and their families. Providing education and support services to children and families such that they can make informed decisions about their nutrition and health, while also providing access to fresh foods maximizes the benefits of many hunger relief programs. A $600,000 grant will provide funding for 50 children to receive psychological, medical, and nutritional support as part of the two-year program and study. Participants and their families will also be provided with food boxes that include fresh fruits and vegetables twice monthly throughout the duration of the program. The outcomes of this program will inform other programs and initiatives throughout the County aimed at bettering children’s long-term health through early medical, nutritional, and lifestyle interventions.
Champions for Health (CFH) facilitates no cost care coordination and access for uninsured adults. Specialty care access for adults without health insurance is a persistent inequity in the medical care safety-net system. Through Project Access San Diego, Champions for Health arranges necessary specialty care for underserved populations earning from 139% to 322% of the federal poverty level, who are not eligible for Medi-Cal or Medicare and have difficulty affording insurance. CFH cares for uninsured patients by mobilizing more than 300 volunteer physicians across 34 specialties to provide complimentary services and by coordinating with surgical centers or hospitals to donate the use of their facilities. Since its inception in 2008, the program has coordinated more than 2,242 surgeries and 31,086 appointments for almost 10,000 uninsured patients. Patients who otherwise have difficulty accessing necessary medical treatment receive all services pro bono. Due to the changes in Medi-Cal requirements, a significant increase in uninsured patients is anticipated. So far in 2026, CFH has seen a 31% increase in patients and a 75% increase in referral load. The increase in need necessitates additional care-coordination capacity. Case management is often complex and includes coordinating care, diagnostic exams, surgery share of cost, transportation, and medication. A $300,000 grant would allow CFH to increase their case management staff and capacity to connect patients with needed health care, while offsetting costs that would otherwise be passed on to referring providers or community clinics. Structured navigation through CFH prevents delayed diagnoses, worse health outcomes, disability, incomplete treatment, and avoidable emergency care. $125,000 of the grant funding would allow CFH to cover 100 medically necessary specialty care referrals from Federally Qualified Health Centers participating in the Safety Net Bridge program.
Linkage to the County of San Diego Strategic Plan
Today’s proposed action supports the Equity, Sustainability, and Community Initiatives in the County of San Diego’s 2026-2031 Strategic Plan. This action advances the County’s equity goals by addressing health disparities for residents likely to be impacted by federal cuts. This action advances the County’s Sustainability goals by reducing food waste and mitigating some of the effects of poverty. This action advances the County’s Community initiatives by partnering with trusted community organizations to maximize the resources available to meet public needs.
Respectfully submitted,
TERRA LAWSON-REMER MONICA MONTGOMERY STEPPE
Supervisor, 3rd District Supervisor, 4th District
Attachment(s)
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