Congress last week passed House Resolution 1, the sweeping federal budget bill that includes significant cuts to Medicaid. Combined with changes in the state budget, these cuts could result in more than 50,000 Contra Costa residents losing healthcare coverage over the next several years.

Our health department is anticipating budget reductions of up to $200 million per year, which will be gradually implemented, with the most significant impacts beginning in 2027. This will directly impact our community.

At a time when our patients need a strong community healthcare system the most, we will be challenged by the loss of thousands of insured patients and hundreds of millions in revenue, as funding for outpatient and emergency care is reduced or eliminated. We also expect that many of our clients will be affected by reductions to CalFresh (SNAP), deepening hardship for the communities we serve.

Despite these challenges, our mission remains unchanged. We must care for those who need us most. We are actively planning for these impacts – improving efficiency, strengthening partnerships, and aggressively advocating for the resources we need to keep our community healthy.

That includes working closely with the Employment & Human Services Department to help ensure as few residents as possible lose coverage. We are also creating a cross-divisional working group to reinforce the basic health care program – our county program that helps serve the medical needs of those with no insurance.

I want you to know that leadership is fully aware of the stress these changes cause on all of us – both our community and our staff. I also want you to know that at least for the immediate future, we do not anticipate layoffs or large-scale, budget-related reductions in service.

Contra Costa Health employees are the beating heart of our county’s healthcare system, and your work matters now more than ever. We are committed to supporting you and protecting the vital services our community depends upon, no matter the challenges.

With Appreciation,

Ori Tzvieli, MD MS | He/Him

Chief Executive Officer and Health Director (Interim)

Health Officer, Contra Costa County

• View the 2025 PIT count summary(External link)

• Homelessness decreased by more than 30% in Central, East and West County.

• Temporary and permanent housing beds increased by 34% since 2023.

• Substantial local progress, including a 60% drop in Martinez, 46% in Richmond and 40% in Antioch.

These results underscore the importance of the services we provide to support some of our community’s most vulnerable residents.

CCH is working hard on many fronts to create more housing opportunities. In recent years, we’ve opened two Homekey facilities, including El Portal Place, which began welcoming residents in October. We know the work is far from over, but we also know it’s making a difference.

Following up on from our message about the May State budget revision, I wanted to give you a brief update on where things stand now.

Since May, the Legislature and Gov. Newsom have continued negotiating and the State passed its 2025-26 budget, which will take effect July 1. While this latest version of the budget reflects several compromises negotiated by lawmakers, it will still have a concerning impact on our community, especially adult undocumented immigrants. Here are a few of the health-related line items:

• The State will re-establish asset tests to determine Medi-Cal eligibility. Individuals with $130,000 in assets and couples with $195,000 in assets won’t be eligible for Medi-Cal anymore.
• Starting Jan. 1, 2026, the state will freeze enrollment in Medi-Cal for adults with undocumented immigration status (although those who already have Medi-Cal will be grandfathered in).
• Undocumented adults still on Medi-Cal will have to pay a monthly $30 premium to retain their benefits (down from $100 in the Governor’s May proposal) after Jan. 1, 2027.
• Dental benefits for undocumented adults on Medi-Cal are being eliminated after July 1, 2026.
• The State will also end enhanced reimbursement rates for undocumented adult visits at our Federally Qualified Health Centers starting July 1, 2026. As I mentioned before, this means we would receive much less funding for the same care.

There are roughly 50,000 adults on Medi-Cal with unsatisfactory immigration status in Contra Costa who are patients at CCRMC & Health Centers. It will be critical to get the uncovered portion of this population enrolled in Medi-Cal before the January 1 cutoff date.

I am worried that as a result of the changing Medi-Cal rules we will see more people delaying care and ending up in our emergency room – or worse -- when their conditions become critical.

It’s still to be determined exactly how all these changes will affect our operations. Obviously, some parts of the department (such as the Health Plan and our delivery systems that are funded largely by Medi-Cal) will be more impacted than others (regulatory programs like Environmental Health that rely on local fees). Meanwhile, the federal budget is still being negotiated and we don’t yet know how that will further change our outlook.

As things become clearer, department leadership will remain in contact with you all and share the latest information. Whatever happens, just remember -- our mission(External link) will remain the same and we will proudly continue to be the safety-net provider for our community.

Juneteenth marks the day in 1865 when Union troops arrived in Galveston, Texas, to enforce the liberation of the last enslaved people in the Confederacy, more than two years after the Emancipation Proclamation. Recognizing the significance of this historical moment, Juneteenth was declared a federal holiday in 2021 to honor the resilience and contributions of African Americans and to promote awareness of the ongoing struggle for racial equality. As a federal holiday, it serves as a reminder of the importance of freedom, justice, and the need to confront the legacy of slavery in America.

That legacy includes the consequences of delayed justice – where rights and protections exist on paper but are not shared, enforced, or accessible to those who need them. As a public health system, we must confront that history by ensuring our services, decisions, and information reach everyone with intention and equity.

This Juneteenth, I want to reaffirm that Contra Costa Health (CCH) is committed to upholding dignity, safety, and equity for all. We must not hinder the sharing and provision of care. Instead, let us be intentional in our outreach and services. Let us stand united for everyone and renew our commitment to creating a health system where access to quality healthcare and achievement of health equity are universal rights, not delayed or conditional.

Through our Black Infant Health program, Perinatal Equity Initiative, and other similarly focused efforts we are actively addressing systemic health disparities with culturally responsive, community-driven care. These programs connect families to essential resources, alleviate stress and isolation, and foster safer, more empowering pathways to wellness. 

This commitment to equity is an integral part of our broader work, encompassing our collaborations with community organizations, our internal equity initiatives, and our engagement with the Office of Racial Equity and Social Justice. 

Juneteenth calls us to celebrate progress, reckon with history, and recommit to a future where health and dignity belong to everyone. Thank you to each of you who helps make that future possible. 

In celebration and gratitude,

Ori Tzvieli, MD MS

Chief Executive Officer and Health Director (Interim)

Health Officer, Contra Costa County

A message on behalf of Board of Supervisors Chair Andersen and the County Administrator's Office.

Contra Costa County stands with our immigrant communities. We know recent federal immigration actions have caused fear and confusion for many across our region and beyond. Our commitment to serving all people, regardless of immigration status, has not changed.

County services like healthcare, public assistance, and mental health support are provided to all, without exception. We operate within our legal authority, focusing on community trust and public safety —not immigration enforcement.

Our community is stronger because of our differences, and we remain committed to dignity, fairness, and access for all. We also support your right to express concern through peaceful protest. In times like these, showing up for each other — in voice, in action, and in care — is how we move forward.

Our strength lies in the people who call this County home. You are not alone, and we will continue to stand with you.

Need support or information?

• Visit Immigration Resources & Public Charge Information | EHSD [ehsd.org](External link) for information about immigration resources in our area
• Call or text 988 for 24/7, confidential support through the Contra Costa Crisis Center.
• The Contra Costa County Library is hosting a Know Your Rights online presentation on Monday, June 23 at 11 AM. Learn your rights when interacting with ICE and the immigration system. The program will have a live Spanish interpretation. To register click here(External link).

****

El Condado de Contra Costa apoya a nuestras comunidades de inmigrantes. Sabemos que las recientes acciones federales de inmigración han causado miedo y confusión para muchos en nuestra región y más allá. Nuestro compromiso de servir a todas las personas, independientemente de su estatus migratorio, no ha cambiado.

Los servicios del condado, como la atención médica, la asistencia pública y el apoyo a la salud mental, se brindan a todos, sin excepción. Operamos dentro de nuestra autoridad legal, enfocándonos en la confianza de la comunidad y la seguridad pública, no en la aplicación de la ley de inmigración.

Nuestra comunidad es más fuerte debido a nuestras diferencias, y seguimos comprometidos con la dignidad, la equidad y el acceso para todos. También apoyamos su derecho a expresar su preocupación a través de la protesta pacífica. En tiempos como estos, nos apoyamos los unos a los otros, en la voz, en la acción y en el cuidado, es la forma en que avanzamos.

Nuestra fuerza radica en las personas que llaman hogar a este condado. No están solos, y continuaremos estando a su lado.

¿Necesita apoyo o información?

• Visite Recursos de Inmigración e Información de Carga Pública | EHSD [ehsd.org](External link) para obtener información sobre recursos de inmigración en nuestra área
• Llame o envíe un mensaje de texto al 988 para obtener apoyo confidencial las 24 horas del día, los 7 días de la semana a través del Centro de Crisis de Contra Costa.
• La Biblioteca del Condado de Contra Costa está organizando una presentación en línea de Conozca sus Derechos el lunes 23 de junio a las 11 a.m. Conozca sus derechos al interactuar con ICE y el sistema de inmigración. El programa contará con una interpretación en vivo al español. Para inscribirse haga clic aquí(External link).

As I shared last week, Contra Costa Health is evolving, not only in how we organize and support our teams, but also in how we respond to a changing fiscal landscape. As part of our ongoing transformation work, the Office of the Director is bringing together a range of essential services – including communications, quality, compliance, facilities, executive functions, and more – that every division depends on.

By organizing these areas under one umbrella, we are creating a structure that helps ensure all teams have clearer, more consistent access to the support they need. This new structure is led by our three deputy directors:

• Lavonna Martin oversees capital planning, health equity, Office of the Director administration, and Detention Health.
• Matt Kaufmann supervises communications, personnel, and an in-development, department-level office to coordinate compliance-related activities across the department.
• Rachael Birch leads our department-level quality efforts, strategic initiatives, and informatics and technology.

Several of these new offices are still under development, and we will share more about them in coming months. Each deputy director also supports the leadership of different divisions and branches. Together these directors help connect our day-to-day work with the broader resources of the department, reducing duplication, encouraging collaboration, and giving division leaders clear points of contact.

I am also excited to share several recent leadership transitions that reflect the deep talent within our organization:

• Dr. Sergio Urcuyo has been appointed Chief Medical Officer for Contra Costa Regional Medical Center & Health Centers (CCRMC&HC)
• Shannon Abella has stepped into the role of interim Chief Operating Officer for CCRMC&HC
• Helena Martey has taken on the role of interim Chief Nursing Officer for CCRMC&HC
• Mary Jane De Jesus-Saepham has been promoted to Health Services Personnel Manager
• Shulin Lin has joined CCH as Deputy Chief Financial Officer

Please join me in congratulating (and welcoming) these exceptional colleagues.

These changes are part of our broader effort to make CCH more connected, more coordinated, and more supportive of the people who make our mission possible. I am grateful to all of you for the work you do every day, and I look forward to continuing this journey together.

With Appreciation,

Ori Tzvieli, MD MS
Chief Executive Officer and Health Director (Interim)
Health Officer, Contra Costa County

With both state and federal budgets still in flux, we are taking measured steps to navigate uncertainty in the months ahead. I want to share a brief update about what we know so far and share what we are working on to ensure Contra Costa Health remains stable and focused on its mission.

To start, we are implementing two department-wide policy changes, effective today:

• Hiring pause. Any new hiring or filling of current vacancies must receive freeze approval from the Office of the Director.
• Travel approval. All out-of-county travel will require prior approval from the Office of the Director.

These measures are intended to help us manage resources carefully while we learn more about the evolving budget picture. If you have questions or need to request an exception, please contact your division head.

Earlier this month, Governor Newsom released his revised state budget proposal (the “May Revise”). While the final budget will be negotiated through June, some proposals, especially around Medi-Cal, could affect many of the people we serve.

The most significant proposed changes include ending new Medi-Cal enrollment for adults with unsatisfactory immigration status in January 2026, and requiring those who remain enrolled to pay a $100 monthly premium beginning in 2027. If adopted, these changes could cause as many as 40,000 CCH patients to lose their healthcare in the next two years.

CCH is the safety-net provider for our County, so I want to assure everyone that we will continue to serve this population. However, when patients have less access to primary and preventive care, we are more likely to see them only when their health concerns become serious enough to drive them to emergency departments.

The May Revise also proposes ending enhanced reimbursement rates for undocumented adult visits at our Federally Qualified Health Centers, meaning we would receive much less funding for the same care.

Altogether, these proposed changes could result in as much as $25 million in reduced revenue in FY 2025–26, and up to $35 million in FY 2026–27. Federal funding changes are also expected later this year, adding to the uncertainty and potentially further reducing the number of people eligible for Medicaid (Medi-Cal). Our county leadership is working with our state and federal partner organizations to protect health coverage as much as possible.

It’s important to note that CCH does not currently anticipate any reductions in services or staff. The transformation efforts already underway are helping us stay adaptive and resilient.

Before closing, I want to take a moment to acknowledge the recent passing of former Contra Costa Supervisor Federal Glover. Supervisor Glover was a lifelong public servant and steadfast champion for health and equity in our community. His leadership helped shape many CCH programs and partnerships. Our thoughts are with his family, loved ones, and the many people whose lives he touched.

I will continue to share updates as we know more. Thank you for your flexibility, thoughtfulness, and unwavering commitment to the people of Contra Costa.

Sincerely,

Ori Tzvieli, MD MS
Chief Executive Officer and Health Director (Interim)
Health Officer, Contra Costa County

Contra Costa Health (CCH) has secured about $98 million in state funding to build three new facilities to better serve county residents in need of mental health and recovery services.

The funding comes from California’s Behavioral Health Continuum Infrastructure Program (BHCIP), a multi-year state initiative to improve behavioral healthcare infrastructure paid through Proposition 1.

Gov. Gavin Newsom and the state Department of Health Care Services (DHCS) announced the awards this week.

“We are grateful to Gov. Newsom and DHCS for recognizing the need to invest in this kind of infrastructure in Contra Costa County,” said Candace Andersen, chair of the county Board of Supervisors. “We desperately need more beds for residential care and treatment.”

Projects selected for funding include:

• Delta Recovery Center (Oakley)
  A campus to include a 16 bed-adult residential treatment center and a 16-bed mental health rehabilitation center.
  
  
• Los Medanos Recovery Center (Pittsburg)
  A hub including a sobering center, crisis triage center, withdrawal management program and outpatient behavioral healthcare services.
  
  
• Sherman Recovery Center (Pleasant Hill)
  A 16-bed adult residential treatment and transitional residential facility designed to support adults with behavioral health needs in a structured setting.

“These investments help us to meet people where they are, offering meaningful treatment and support close to home,” Contra Costa Supervisor Ken Carlson said. “They are a vital part of our ongoing efforts to reduce emergency room visits, reduce contact with the criminal justice system, and support recovery in our community.”

The Board of Supervisors yesterday appointed Supervisors Carlson and Andersen as its representatives on the recently established Behavioral Health Commission, which advises the full board on matters relating to mental health, substance use disorder and behavioral health in the county.

Contra Costa County owns the properties on which all three facilities will be built. More details about the projects and their timelines will be released in early summer.

“We have a critical need for these programs to better serve Contra Costa residents throughout the County and close to their home communities. The addition of these facilities will expand access to essential care to better support people who are in need of and would benefit from the mental health treatment services to be provided,” said Dr. Suzanne Tavano, Director of Behavioral Health Services for CCH. “This investment will make our county healthier, safer and more able to provide appropriate care for all our residents.”

Statewide, Proposition 1 funding is expected to create over 5,000 residential treatment beds and expand outpatient capacity by 21,800, with a focus on helping individuals who are homeless or at risk of institutionalization.