Dear Colleagues:

As Contra Costa Health enters a period of rapid change, I am sharing what we know and how we are preparing for the months ahead. New state and federal policies will alter eligibility, reimbursement, and the landscape in which we deliver care.

CCH faces significant financial pressure. We project these changes will reduce our revenue by more than $330 million over four years, including major cuts in supplemental payments and fee-for-service reimbursement. At the same time operating expenses, labor costs, and required capital projects continue to rise.

These forces will affect how we operate. As Med-Cal eligibility changes take effect, Contra Costa Health Plan may lose as many as 100,000 members, meaning more residents will be uninsured.

This increases demand for our services at a time when reimbursement will be falling, which is why strengthening operations and spending wisely is essential.

To manage these pressures responsibly, we are taking steps across the department to operate more efficiently and reduce costs without reducing essential services. This includes improving staffing models, strengthening billing and revenue processes, reducing external spending, and finding better ways to use our space, technology and supplies. These efforts are already underway, and many of you are contributing to them.

Our goal is to stabilize our finances while protecting the services our community relies on and the workforce that delivers them. The work we are doing now will help us manage and mitigate these state and federal changes.

Later this month, we will present this financial outlook in detail to the Board of Supervisors. Sharing this information publicly is an important part of my commitment to transparency and responsible planning.

We will continue to communicate as openly as possible as the policy landscape evolves. Through all this, our mission remains the same. Contra Costa Health has weathered major transitions before by staying grounded in service, compassion, and the needs of our community. I am confident we will do the same in the year ahead.

Thank you for everything you do each day. Your work matters deeply, and it is the foundation of our ability to navigate this moment together.

With deep respect,

Grant Colfax, MD
Chief Executive Officer
Health Director, Contra Costa County

The Holiday Food Fight is a friendly competition between Contra Costa and Solano County employees to raise funds for the Food Bank of Contra Costa and Solano. This effort, spearheaded by individual county departments, has raised nearly $2.7 million since 2004. The county that raises the most funds per employee will win the Big Apple trophy. The trophy and bragging rights pass back and forth annually, but the real winners are the recipients of the funds you raise: those who go hungry in our communities.

Donate today and help your county win the Big Apple!

Counties Care - Food Bank of Contra Costa and Solano

Dear Colleagues:

We have had an eventful few weeks across the department. I want to share several important updates and offer my thanks for the extraordinary work happening throughout Contra Costa Health.

Leadership Update

I am very pleased to announce that Dr. Ori Tzvieli has accepted the permanent role of Director for our Community Health & Safety Branch, which includes the Public Health, Environmental Health, Emergency Medical Services, Hazardous Materials and the Health, Housing & Homeless Services divisions.

Many of you know Ori from his steady leadership as our Health Officer (a role he will continue) his 25+ years serving Contra Costa County in our system, and his capable tenure as interim department CEO earlier this year.

He brings deep knowledge of our work and deep commitment to caring for our patients and clients, and I am grateful he is stepping into this role at such a critical moment for our organization.

I also want to thank Dr. Sefanit Mekuria for serving as interim branch director for most of the year. Sofe’ stepped in during a period of transition and provided steady, thoughtful leadership. She now returns to her position as Public Health Director. We are fortunate to have both guiding this important work.

SNAP Response

Many Contra Costa Health teams ably supported the county’s emergency response to the federal government shutdown, which halted Supplemental Nutrition Assistance Program (SNAP) disbursements earlier this month. Even a brief interruption puts thousands of families at risk, and our teams responded quickly to help.

Staff at our health centers in West County, Brentwood, Martinez and North Richmond all pitched in with the Equity team to receive and distribute food in our lobbies – 2,915 boxes in all over two weeks. A box feeds a family of four for two weeks.

This was part of a coordinated effort with the Employment & Human Services Department (EHSD) and Food Bank of Contra Costa and Solano to ensure access in neighborhoods with great need in our community.

Fortunately, all our recipients did receive their benefits for November. But I was encouraged by the decisive actions of EHSD and the Board of Supervisors when that outcome was in doubt. The Board identified $21 million in emergency funding to cover direct payments for more than 100,000 recipients if needed, and EHSD pushed through enormous logistical challenges to ensure the county was ready to deliver.

Their work, combined with yours, showed what coordinated public service can look like. We will need the same level of teamwork as we prepare for a rapidly changing federal funding environment in the months ahead. Thanks to all who participated.

Town Hall

Thank you also to more than 250 staff members who joined our first virtual staff town hall last week. I appreciated the thoughtful questions and the candor of the discussion. We covered many topics, including the federal budget outlook, county remote work policy, capital projects at Regional Medical Center, and opportunities for staff development and advancement. Your engagement and insights make these conversations meaningful.

Two more staff town halls are also scheduled:

• Tuesday, December 2, 8-9 a.m.

• Wednesday, December 10, 12-1 p.m.

I hope to see many of you there. You can also submit questions in advance at together.cchealth.org.

Thank you for everything you do for our patients, clients and the community.

Sincerely,

Grant Colfax, MD
Chief Executive Officer
Health Director, Contra Costa County

Dear Colleagues:

As we enter the final months of 2025, here are some updates about Contra Costa Health’s direction and how we are preparing for the challenges ahead.

Significant federal and state funding reductions are on the horizon. Programs that fund care for patients with low income are scheduled for cuts, including the Disproportional Share Hospital (DSH) and Global Payment Program (GPP). Meanwhile temporary federal funding increases from the pandemic period are being phased out.

These changes will affect how we are reimbursed for care and how we sustain critical services. Our finance and operations teams are taking a close look at how we can operate more efficiently and strengthen our financial position. We are approaching this work thoughtfully – with data, teamwork and transparency guiding every decision.

At the same time, we’re modernizing systems, building leadership capacity, and focusing on the services that matter most to our mission and our community. Our goal is to protect patient care and minimize impacts on staff as we navigate these changes together.

Lending Support During the Federal Shutdown

To support county residents affected by CalFresh delays, CCH is partnering with the Employment & Humans Services Department and the Food Bank of Contra Costa & Solano to distribute food at EHSD offices and our clinics in Brentwood, North Richmond, West County and Martinez.

My thanks to all involved in making this happen so quickly.

Welcoming New Leaders

We are continuing to build the team that will help lead CCH into the next phase of its work:

Harmandeep Madra, MSN, FACHE – Chief Nursing Officer, CCRMC
Harmandeep joins us on November 17 from Kaiser Santa Clara, where he directed Emergency and Urgent Care Services for more than 85,000 patients annually.

Rick Ortiz – Chief of Plant Operations, CCMRC
Rick brings extensive hospital engineering experience from Crothall Healthcare in Casper, Wyo., Virginia Mason in Seattle and Mercy Hospital in Cincinnati.

Jenny Robbins – Director, Community Response Division
Jenny leads our new division coordinating field-based teams and improving collaboration across programs that serve people in crisis or without stable housing.

Our search for a permanent Finance Director and Health Plan Director will continue into the first quarter of 2026. These are key roles for our future, and I encourage you to share our job postings with your professional networks.

Listening and Staying Connected

Over the past several weeks, I’ve had the opportunity to visit with staff in Information Technology, Equity, and Alcohol and Other Drug Services, and I look forward to continuing these visits throughout the winter.

I also hope you’ll join me for our upcoming staff town halls to ask questions and share ideas:

• 3-4 p.m. Thursday, Nov. 13
• 8-9 a.m. Tuesday, Dec. 2
• 12-1 p.m. Wednesday, Dec. 10

Please submit questions in advance at together.cchealth.org.

Moving Forward Together

As we face a changing environment, I’m encouraged every day by the resilience and professionalism of this team. Your work in clinics, hospitals, offices, and in the field continues to improve lives and strengthen the health of our communities.

We have challenges ahead, but we also have clear purpose and extraordinary people. By staying connected, sharing ideas, and supporting one another, I’m confident we’ll continue to deliver the excellent care and compassion that define Contra Costa Health.

Thank you for all that you do.

Grant Colfax, MD
Chief Executive Officer
Health Director, Contra Costa County

We are monitoring the situation closely, in coordination with our county and state partners, including the California Department of Health Care Services and other agencies that administer federal funds supporting Medi-Cal, public health and social services.

If developments occur that could affect our programs, employees, or the services we provide, we will communicate any updates promptly.

We understand that the shutdown creates uncertainty, both for staff and for the communities we serve, and we appreciate your continued focus on serving the people of Contra Costa County with excellence and compassion.

Thank you for all that you do,

Grant Colfax, MD
Chief Executive Officer
Health Director, Contra Costa County

The Contra Costa Family Medicine Residency Program, one of the largest and oldest programs of its kind, is marking its 75th year of training future family physicians.

Read the full press release: cchealth.org/Home/Components/News/News/953/415

The Residency recently held a reunion celebration at the Contra Costa Country Club, which brought together more than 200 alumni from across the country and current residents.

Dear Colleagues:

I am very pleased to share that Nicole DeAraujo-Roman has joined Contra Costa Health as our new Director of Detention Health Services.

Nicole brings a wealth of experience in healthcare operations, strategic planning, and organizational transformation, and we are excited to welcome her leadership in overseeing the delivery of high-quality, accessible, and efficient health services within our detention settings. Her focus will be on strengthening care systems, improving operational workflows, and ensuring compliance with public health standards.

Nicole had a distinguished career at the Department of Veterans Affairs, where she served in various executive roles. She is known for her collaborative leadership style, data-driven decision-making, and commitment to equity in healthcare.

Nicole holds a Master of Science in Healthcare Administration and a BA in Psychology. Outside work, she enjoys exploring new places, cooking with her family, and cheering on her 6-year-old stepson at his baseball games with her husband, a firefighter.

Please join us in welcoming Nicole to her new role. We look forward to the vision, expertise, and energy she brings to Detention Health Services.

Thanks,

Grant Colfax, MD
Chief Executive Officer
Health Director, Contra Costa County

Thank you for your warm welcome over these past few weeks. I so appreciate the great work happening here at Contra Costa Health, and have enjoyed meeting many of you.

I’m committed to transparency and communication. To that end, I am sharing updated projections on how changes in federal law, specifically HR-1, as well as state policy changes, are projected to affect our department and community. By 2029, it is estimated that nearly 100,000 Medi-Cal members in Contra Costa County will lose health coverage, resulting in more than $360 million in cumulative revenue loss.

These challenges are real. Yet I am encouraged by what I see as I visit workplaces and spend time with staff across CCH. Your commitment, resilience and focus on excellent care are inspiring, and position us to respond well to whatever comes next.

Public support is also growing. Elected leaders recently toured Contra Costa Regional Medical Center and expressed strong support for our essential mission. That support will be vital as we navigate the road ahead.

Alongside funding threats, shifting federal vaccine policies are adding confusion at a critical time of year. I want to be clear: At CCH, we remain committed to science- and evidence-based practices, and will champion vaccine policy that follows the data.

We continue to align with California Department of Public Health guidance. Protecting the health of our patients, staff and community will always be a guiding priority.

Our shared goal is to provide the care and services our community depends on. Over the next few months, Contra Costa Health will be working with community stakeholders, providers, and other county departments to set priorities and navigate the changing federal landscape.

To help us connect, I will be visiting facilities and holding in-person town halls across our system in coming weeks. These gatherings are opportunities to hear more, ask questions, and share ideas. Dates and times will be shared soon – hope to see you there.

Thank you for all you do every day. I look forward to connecting and moving forward together.

With gratitude,

Grant Colfax, MD
Chief Executive Officer
Health Director, Contra Costa County