Bexar County’s budget staff recommended that commissioners make significant cuts the county public health department’s budget and staffing on Thursday during a budget workshop, as American Rescue Plan Act funding expires and the county faces difficult budget decisions.
The county public health department was established in 2022 in response to health inequities exposed by the COVID-19 pandemic.
Andrea Guerrero, the department’s director, asked commissioners to retain 27 positions and a $2 million annual budget for the department. The county’s budget staff recommended less than half of that, instead allocating $984,000 and reducing staff to 12 positions total.
The department would be able to maintain key programs despite the cuts, including its Safety Team Active Response (STAR) program, which supports victims of domestic abuse with a team of case workers, the Senior Justice Assessment Center (SJAC), which aims to prevent and intervene in cases of elder abuse, as well as behavioral health programs.
Several administrative and coordination roles, as well as half of the domestic violence case manager positions, would be eliminated under the proposed cuts. According to the county budget staff presentation, the STAR program employed more staff than programs in similarly sized cities despite serving significantly fewer people.
The budget office recommended reducing the current 12 case manager positions to five, levels Guerrero said would be unreasonable for the STAR program.
“We’ve had seven domestic violence homicides this year, compared with nine total last year,” she said. “And so we really feel like the current staffing, or even a small reduction, would be essential in order to handle the volume.”
Commissioner Grant Moody (Pct. 3) recommended leaning on University Health’s Institute for Public Health, which was set up around the same time after the pandemic, to pick up some preventative health services lost under budget cuts.
It’s unclear what will happen to the preventative health division’s dietician and nutrition specialist, positions that were a part of the original department budget but have remained vacant, according to Guerrero.
“There’s still some unanswered questions,” said Commissioner Rebeca Clay-Flores (Pct. 1). “What have you guys done for diabetes? Sadly, San Antonio is the top in the country for amputations, so there’s so many things that we need to tackle. What’s the plan? How do you plan to continue to impact public health, even though the dollars are gone?”
Bexar County Judge Peter Sakai commended the department’s accomplishments since 2022, and said that the STAR program would likely be able to continue at a reduced capacity.
“This budget discussion is probably the most difficult one for me because of the scope of the work, the positions that have been created, and the impact to the community,” Sakai said.
But he also added that the public health department was one of the biggest “big ticket” costs at a difficult time for the county budget.
“Everybody was told that come 2026 calendar year, there was going to be a day of reckoning, and here we are,” Sakai said, referring to the expiration of ARPA funding. “And … excuse my language, [but] some are going to win, some are going to lose.”
