Eight Federally Qualified Health Centers (FQHCs) operate in the East Bay, receiving federal funds to provide healthcare services to medically underserved communities. These health centers serve 290,000 people—regardless of income level or insurance status—at over 140 clinic locations in Alameda and surrounding counties. Their continued existence is under threat.
FQHCs have started to experience severe financial and operational strains due to federal policy changes and funding cuts. Federal legislation H.R. 1 cut $30 billion from Medi-Cal and restricted California’s ability to finance the state’s share of Medi-Cal. Ending reimbursement for treating undocumented patients or certain immigrants has left FQHCs to confront heavy revenue losses.
Estimates project 3.4 million state residents could lose coverage, including 127,000 in Alameda County. This increase in uninsured patients is expected to lead to a surge of emergency room visits, as hospitals are required to treat patients regardless of their ability to pay. Prop 40, on the California ballot in November, would address this shortfall by raising tens of billions of dollars through a one-time state tax on billionaires. Polling shows slim majorities of voters supporting Prop 40, but also Props 41 and 42. Props 41 and 42, purportedly about other subjects, were designed to cancel the billionaire tax—a larger vote total for either proposition would nullify Prop 40.
Also on the ballot in November is Prop 44 which would cap FQHCs spending for management and administrative expenses at 10%. SCIU-UHW, the health workers union which proposed Prop 44, argues that its passage will improve patient care. Nearly 100 medical and community organizations, ranging from Planned Parenthood Affiliates of California to the California American Academy of Pediatrics, oppose the measure. They argue this proposition will cut $1.7 billion from community health clinics, resulting in 88% of clinics operating at a loss.
Between impending federal cuts and the potential for significant restrictions to operational expenditures, the importance of sound stewardship of FQHC funds to support quality care for those in need has perhaps never been greater.
Healthcare workers at Lifelong Medical Care participated in a one-day strike in Richmond on Sept. 28. Lifelong employees are seeking wage increases and better working conditions. A Lifelong representative said management offered employees a 6.38% wage increase over three years as well as bonuses and other benefits. The current inflation rate is 3.4%. According to its most recent publicly available tax filing, compensation for Lifelong CEOs climbed from $377,560 to $730,941 over four years, an increase of 93%. Compensation payments to other Lifelong executives, excluding those with MD or DDS degrees, totaled over $2.6 million—much higher than at any of the other FQHCs. These positions appear largely nonclinical in nature, including a chief people officer whose compensation totaled $621,650.
The highest paid employee at any of the FQHCs is Jane Garcia, chief executive officer of La Clinica de La Raza. Her compensation package totaled $992,957. Three years earlier, Ms. Garcia received $403,474 for serving as CEO of La Clinica. While most of the largest contracts by FQHCs were for clinical staffing, La Clinica’s five largest contracts totaling $7,585,420 were for IT, security and maintenance services.
Lifelong and La Clinica were asked whether they have taken steps to address concerns raised by Prop 44 proponents and what effect its passage would have on their operations. Lifelong stated it began making changes to its executive team in 2025, and its current executive team has fewer chief roles. Both FQHCs estimated annual losses of around $20 million if Prop 44 passes, and significant cuts to patient care such as translation services, patient coordinators, enrollment navigators and transportation services.
The fate of Alameda County community health clinics will become clearer after ballots are counted in November. The need to ensure that spending at these clinics optimizes patient care will be ongoing.
