Massachusetts Medicaid Chief Tapped to Lead SF Homelessness Department

Mayor Daniel Lurie announced Mike Levine — the head of Massachusetts' $23 billion Medicaid program — as the new leader of San Francisco's Department of Homelessness and Supportive Housing, betting that a healthcare systems expert can sustain record-low encampment numbers amid looming federal funding cuts. The appointment, confirmed by the Homelessness Oversight Commission, comes as Lurie marks one year of his Breaking the Cycle initiative with a public progress report delivered at 33 Gough, a tiny home village operated by Urban Alchemy.

• Mike Levine, who oversees healthcare for nearly 2 million people and 10,000 individuals experiencing homelessness in Massachusetts, will start as HSH Executive Director on June 22

• Tent encampments hit the lowest levels on record under the Breaking the Cycle plan's first year, with more people accepting shelter offers

• The 822 Geary stabilization center has leveraged $4.5 million in Medi-Cal funding, establishing a model the administration wants to scale citywide

• Lurie set near-term targets: continued encampment reductions, more people out of large vehicles, and sustained Journey Home reunifications in the mid-40s per month

A Healthcare Bet on Homelessness

Why it matters: The decision to recruit a Medicaid administrator — not a housing specialist or a nonprofit executive — to lead San Francisco's homelessness department is a strategic signal. Mayor Daniel Lurie's administration is staking its approach on the premise that healthcare integration and fiscal sustainability are now the central challenges, not just shelter capacity or outreach models.

Where things stand: Mike Levine currently runs Massachusetts' Medicaid program, where his team serves as the primary statewide payer for behavioral health and addiction treatment services. In that role, he described direct responsibility for more than 10,000 individuals experiencing homelessness.

"Homelessness is more than a housing issue," said Mike Levine, incoming Executive Director of HSH.

He pledged to aggressively pursue every available federal and state funding stream, particularly Medi-Cal:

"We cannot leave money on the table in times like these."

Lurie framed the hire as essential to protecting city services from Washington's budget knife

"[Levine] understands how to maximize state and federal funding at a time when cuts are coming and every single city dollar matters in San Francisco."

Lurie praised outgoing Director Shireen McSpadden, who will remain through the end of June to ensure a smooth handoff, calling her "crucial to creating this incredible foundation that we have." McSpadden's decades of public service helped build the department's current infrastructure.

What's next: Levine confirmed his start date as June 22. He said his early months will focus on listening — meeting providers, community members, frontline teams, and clients. The administration has outlined 100-day, six-month, and one-year benchmarks, though specific targets beyond the broad goals discussed were not detailed at the press conference.

Breaking the Cycle: Year One by the Numbers

Why it matters: The progress report sets a public baseline the Lurie administration will be measured against as it scales services, navigates federal uncertainty, and asks San Franciscans to judge whether its approach is working.

Where things stand: One year after launching the Breaking the Cycle plan — built around getting people care, making public spaces safer, and holding government accountable for results — the mayor pointed to several metrics:

• Tent encampment numbers have hit the lowest levels on record.

• More people are accepting shelter offers under a retooled street team model.

• More families living in large vehicles are transitioning to stable housing, aided by new RV legislation.

• Journey Home reunifications are averaging in the mid-40s per month in recent months.

• Medication-assisted treatment for fentanyl addiction has increased.

"In the past year, tent encampment numbers hit the lowest levels we've recorded. More people are accepting offers of shelter under our new street team model approach," Mayor Daniel Lurie said.

The mayor anchored the integrated-care argument at 822 Geary, a 24/7 stabilization center he described as more effective at connecting people to residential treatment, shelter, or reunification with loved ones — and one that has already drawn down $4.5 million in Medi-Cal funding. Changes at Public Health under Director Dan Tsai were credited with bringing in new funding streams and easing pressure on the city's general fund.

"We will not solve homelessness by treating it separately from drug addiction or mental illness. People don't experience these challenges separately, and neither can we," Mayor Lurie said.

Lurie acknowledged conditions on the streets remain difficult, referencing what he observed that morning. He outlined near-term expectations:

"We have to keep driving these numbers down, getting more people out of large vehicles and into stable housing. We need to see a continued reduction in tent encampments."

What's next: The administration's 100-day, six-month, and one-year targets for the new director will serve as the next round of public accountability markers. The ability to replicate the 822 Geary funding model at additional sites — and to maintain progress as federal dollars tighten — will be the key test of whether the healthcare-integration strategy can scale.