SUBJECT
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RECEIVE UPDATE AND PRESENTATION FROM THE AD HOC SUBCOMMITTEE ON SOCIAL SAFETY NET AND BEHAVIORAL HEALTH SYSTEMS TRANSFORMATION (DISTRICTS: ALL)
Body
OVERVIEW
On August 26, 2025 (24), the San Diego County Board of Supervisors established the Ad Hoc Subcommittee on Social Safety Net and Behavioral Health Systems Transformation (Ad Hoc Subcommittee) and directed it to advise the Board on two priority areas: developing a coordinated Countywide response to anticipated federal changes to public benefits eligibility systems, and guiding the multi‑year transformation of Behavioral Health Services (BHS) into a standalone organizational structure.
Since its establishment, the Ad Hoc Subcommittee has remained actively engaged, with staff from respective Board offices meeting with County of San Diego (County) staff to provide strategic guidance, monitor progress, and ensure alignment with the Board’s direction. This consistent engagement has enabled early identification of enterprise-wide focus areas, support for operational readiness planning, and coordinated development of assessments related to both federal public benefits changes and BHS structural transformation.
To prepare for this work, County staff executed a contract with Precision Health Strategies on January 15, 2026, securing specialized expertise to conduct an in‑depth assessment of the operational, fiscal, and equity impacts of H.R. 1 on the County and inform strategies to prepare for potential changes to Medi-Cal, CalFresh, and other social safety net eligibility systems. This collaboration has provided critical technical capacity to evaluate federal requirements, model potential impacts on County service delivery, and support the development of a coordinated Countywide response. This work was presented at the Ad Hoc Subcommittee meeting on February 11, 2026.
Today’s item requests that the Board receive an update from the Ad Hoc Subcommittee with a focus on the foundational work that is underway to support a cohesive, equity‑focused transformation of the County’s safety net service system, and to provide the full Board with the information provided to the Ad Hoc Subcommittee on February 11, 2026.
RECOMMENDATION(S)
CHAIR TERRA LAWSON-REMER AND VICE CHAIR MONICA MONTGOMERY STEPPE
1. Receive update and presentation from the Social Safety Net and Behavioral Health Transformation Ad Hoc Subcommittee.
EQUITY IMPACT STATEMENT
Starting on April 1, 2026, counties will evaluate CalFresh applications and renewals under new rules that remove eligibility for certain groups of lawfully present noncitizens, including asylees and refugees. Current estimates show that this change could lead to a loss of CalFresh benefits for approximately 13,000 current San Diego County CalFresh customers over the next year. In addition, starting on June 1, 2026, new or renewing CalFresh “Able-Bodied Adults Without Dependents (ABAWD)” will have to meet work requirements to get or maintain eligibility for benefits. Based on December 2025 enrollment data, it is estimated that approximately 93,500 individuals will be subject to the ABAWD work requirement during the first year of implementation. Today’s item supports the County of San Diego’s (County) ongoing commitment to equitable access to essential safety-net services. By evaluating potential impacts of federal eligibility changes and strengthening coordination across departments, the County is working to ensure that all residents can continue to access timely and reliable services.
SUSTAINABILITY IMPACT STATEMENT
Today’s item supports the County of San Diego’s long‑term sustainability goals, specifically by promoting just and equitable access to essential supports and safeguarding community well‑being. Coordination across departments and analyses underway under the leadership of the Ad Hoc Subcommittee on Social Safety Net and Behavioral Health Systems Transformation collectively ensure the County is more prepared to respond to the emerging needs of the community in response to changes in social safety net eligibility requirements.
FISCAL IMPACT
There is no fiscal impact associated with this recommendation to receive an update and presentation. There will be no change in net General Fund cost and no additional staff years. There may be fiscal impacts associated with future related recommendations from the Ad Hoc Subcommittee on Social Safety Net and Behavioral Health Systems Transformation which would return to the Board for consideration and approval.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
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BACKGROUND
On August 26, 2025 (24), the San Diego County Board of Supervisors established the Ad Hoc Subcommittee on Social Safety Net and Behavioral Health Systems Transformation (Ad Hoc Subcommittee) and directed it to advise the Board on two priority areas: developing a coordinated Countywide response to anticipated federal changes to public benefits eligibility systems, and guiding the multi‑year transformation of Behavioral Health Services (BHS) into a standalone organizational structure.
Key focus areas identified by the Board as part of this direction include evaluating workforce capacity to manage potential increases in eligibility redeterminations, work requirement verifications, or other administrative procedures; assessing administrative readiness to handle increased workload volume; developing communication strategies to ensure residents understand program requirements and available supports; and exploring technology and data solutions to streamline enrollment and case management. The Board also directed the Ad Hoc Subcommittee to strengthen partnerships with legal aid organizations, health care providers, and community-based organizations to support residents in navigating new administrative processes. Today’s update is focused on the safety net service delivery system and the County’s preparedness for federal eligibility changes. This focus aligns with the immediate urgency of analyzing operational impacts associated with H.R. 1 and developing strategies to mitigate potential benefit disruptions to resident access and County service delivery.
Since its establishment, the Ad Hoc Subcommittee has maintained engagement with County staff, who have created a structured forum for cross-departmental coordination and ongoing review of operational readiness. These meetings have enabled staff to surface potential challenges early, identify enterprise-wide dependencies across eligibility functions, and provide the Ad Hoc Subcommittee with real-time insights into workload planning, staffing needs, and process redesign efforts. This regular meeting cadence has also supported alignment across departments as State and federal guidance evolves and the County prepares for various implementation scenarios.
The County executed a contract with Precision Health Strategies on January 15, 2026. Precision Health Strategies is conducting a detailed assessment of the potential fiscal, operational, and equity impacts of H.R. 1 on the County’s public benefits programs. This includes modeling projected increases in eligibility redeterminations and administrative workload, analyzing impacts on historically underserved communities, evaluating risks to service continuity, and identifying mitigation strategies to strengthen County preparedness. These efforts supplement internal County analyses and provide the technical capacity needed to evaluate complex federal requirements and interpret potential implementation timelines.
The Ad Hoc Subcommittee’s early efforts have laid a foundation for a more deliberate and coordinated approach to preparing the safety-net system for State and federal policy changes. Through consistent engagement, cross-departmental coordination, and the integration of external technical expertise, the County is developing a more comprehensive understanding of potential impacts, operational challenges, and opportunities to reinforce system resilience. Today’s update summarizes the initial phases of this work and outlines next steps to ensure that County residents continue to receive timely, equitable access to essential health and social services during this period of policy transition.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s action aligns with the County of San Diego’s 2026-2031 Strategic Plan Initiatives of Community (Quality of Life) and Sustainability (Economy) by taking necessary actions to ensure availability of accessible, timely, and effective services for San Diego County’s most vulnerable residents during a period of State and federal policy transition.
Respectfully submitted,
Terra Lawson-Remer MONICA MONTGOMERY STEPPE
Supervisor, Third District Supervisor, Fourth District
ATTACHMENT(S)
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