The County Board of Supervisors voted today to authorize negotiations and implementation planning with the region’s four Managed Care health plans to fund homeless outreach and housing services currently delivered by County social workers.

The action positions the County to offset a significant share of homeless services costs — up to 78% — currently borne by local taxpayers by allowing the healthcare system to help pay for services already being provided.

“Washington may be pulling back from caring for the sick and poor, but San Diego is finding new ways forward,“ said Supervisor Terra Lawson-Remer, Chair of the County Board of Supervisors. “Today’s action moves San Diego County toward a smarter, more sustainable model — one that can bring new revenue into the County while making sure taxpayer dollars go further to tackle homelessness.”

For decades, local governments have paid for homeless outreach while the healthcare system paid for the downstream consequences like emergency room visits, crisis care, and hospitalizations, but now California’s new healthcare system can help pay for housing-focused services that keep people off the streets and stably housed. 

The Board action directs the County to negotiate agreements with Blue Shield Promise Health Plan, Community Health Group, Kaiser Permanente, and Molina Healthcare under CalAIM — California Advancing and Innovating Medi-Cal — the state’s landmark healthcare reform initiative that allows Medi-Cal Managed Care Plans to reimburse housing-focused services tied to health outcomes.

“While we cannot control funds lost from the federal and state governments, we can control how responsible we are stewarding public resources and protecting the services our residents depend on,” said Supervisor Monica Montgomery Steppe, Vice Chair of the County Board of Supervisors. “This item is part of a broader County effort to identify efficiencies and cost-savings before any service reductions are considered. We are already seeing savings through modernization of communications technology, centralized space management, and updates to County fleet operations.”

Services eligible for reimbursement under CalAIM include housing navigation, security deposit assistance, care coordination, and housing tenancy support — work already provided by the County’s Office of Homeless Solutions (OHS).

The County’s 40-person OHS social work team has conducted homeless outreach, case management, and housing referrals across the region since 2021. An estimated 90% of OHS clients are Medi-Cal eligible — the same population the region’s Managed Care Plans are now responsible for supporting through CalAIM.

REAL SAVINGS FOR SAN DIEGO COUNTY TAXPAYERS

The OHS Regional Homeless Services team carries an estimated annual budget of approximately $7.1 million, costs that have historically been funded primarily by County taxpayers. The County’s new CalAIM strategy is designed to offset those costs in two phases.

In 2026, a $3.5 million state PATH CITED grant will support the County’s buildout of billing infrastructure, electronic records systems, staff training, and administrative processes needed to participate in CalAIM reimbursement.

Beginning in 2027, as the County transitions toward full billing through Managed Care Plan partnerships, projections indicate up to $5.6 million in annual Medi-Cal revenue — potentially offsetting up to 78% of OHS Regional Homeless Services costs, depending on final program design and reimbursement structures.

Every dollar the healthcare system contributes is a dollar the County can direct toward other critical services San Diego residents rely on.

A PILOT IS ALREADY UNDERWAY

The County launched an initial four-person CalAIM pilot in March 2026 to test referral workflows, billing processes, and administrative systems needed to work with health plans at scale. The County is also implementing the OCHIN EPIC Compass Rose electronic records system required for reimbursement billing, expected to be operational by the end of 2026.

The County emphasized that outreach and support services will continue for all populations, including residents who do not meet Medi-Cal eligibility requirements.

“We are designing this model carefully to maximize reimbursement opportunities without narrowing who receives help,” Lawson-Remer said. “No one will be turned away from outreach or support because of insurance status.”