Oakland’s public hospital network is staring at a nine-figure budget crater that could take hundreds of jobs with it. Alameda Health System has warned its Board of Trustees that federal changes to Medicaid could blow roughly a $100 million hole in its 2027 finances and trigger deep staff reductions across its East Bay hospitals. The safety-net system says it must find hundreds of millions in savings to balance a roughly $1.4 billion operating budget that leans heavily on Medi-Cal reimbursements.
Trustees Told To Plan For Steep Medi-Cal Shortfalls
Chief Financial Officer Kim Miranda told the AHS Board of Trustees they need to identify reductions totaling $235 million by 2027. Board materials reviewed by local reporters show projected Medicaid-related revenue shortfalls of about $30 million in 2026, $100 million in 2027 and $150 million in 2028.
The system, which employs roughly 5,000 people, has flagged that about 60% of its revenue comes from Medi-Cal and has identified roughly 372 positions that could be affected as managers work to close the gap. Those figures, and the board’s decision to shed “hundreds of jobs,” were reported by The Oaklandside.
Where The Cuts Would Land In Oakland
Highland Hospital, AHS’s flagship campus in Oakland, provides trauma, maternity and specialty services that serve large numbers of Medi-Cal patients. The Wilma Chan Highland Hospital campus at 1411 E. 31st St is listed on the Alameda Health System website as a central site in the network and outlines inpatient and outpatient services that could be affected if staffing shrinks. Those services are listed by Alameda Health System.
Union Pushback And Worker Concerns
Service Employees International Union Local 1021, which represents many AHS workers, has been organizing against federal Medicaid cuts and warned that reductions could mean layoffs, clinic closures and narrower access to care. Union leaders say they are in negotiations with AHS management over specific job and service impacts and have staged rallies and days of action this year to press for protections, organizing that SEIU 1021 has documented.
How A Federal Law Deepened The Shortfall
The budget squeeze traces back to H.R. 1, the 2025 reconciliation package signed into law in July, which includes changes to Medicaid financing and eligibility that analysts say will sharply reduce federal payments to hospitals and states. Health policy groups and analysts estimate the law will cut federal Medicaid spending by roughly $900 billion to $1 trillion over the coming decade, a move that the Kaiser Family Foundation says will shift substantial costs onto local safety-net systems. KFF has summarized those impacts.
What’s Next For Patients And Staff
AHS trustees said they will work with labor leaders to try to limit frontline clinical cuts while management, support and administrative roles are reviewed as part of the plan to meet the $235 million target. AHS has formally identified about 372 positions that could be impacted, and workers say they fear the reductions will erode services for the county’s most vulnerable patients. “This will affect our whole community. It will affect our loved ones and it will affect healthcare moving forward,” said Veronica Palacios, a Highland worker and former union chapter president, as reported by The Oaklandside…