Snapshot: Appropriation & Staffing Changes from 2023 Budget
| 2023 Budgeted | 2024 Proposed | Net Change | Percent Change | |
| Appropriations | $972,398,008 | $887,964,111 | -$84,433,897 | -8.7% |
| Positions & FTEs | 1105 | 1175 | 70 | 6.3% |
Departmental Highlights
- CDPH’s overall budget is down -8.7% from 2023 in the proposed 2024 budget, one of the largest departmental budget reductions.
- Nearly all of the CDPH budget cuts are to the professional and technical services appropriation (outside contracting), with the bulk of the reduction coming from losses in Coronavirus Local Fiscal Recovery funding and CDC infrastructure/capacity grants.
- All told, CDPH grant funding was down roughly $109 million from 2023, a -12.3% decline. Local funding, a much smaller portion of CDPH’s budget, was up $24.9 million, a 35.5% increase on non-grant funding.
- Despite the budget cuts overall headcount is up a net 70 positions, one of the largest departmental staffing increases. The increase is largely driven by the addition of nursing and clinical staff positions across a number of titles. All told, CDPH’s budget adds 43 nursing positions (including four psychiatric nurse practitioners), 19 mental health crisis clinicians, and 12 clinical therapists.
- The largest staffing reductions came in the department’s epidemiology and infectious disease related positions, including the elimination of 22 communicable disease investigator positions (including one regional investigator position) and 12 epidemiologist positions.
- Despite cuts, CDPH’s largest appropriation remains professional and technical services (outside contracting), which makes up more than half the department’s budget. Pass-throughs to delegate agencies are another 15.9% of the total budget.
Historical Context
As the city’s point department for infectious disease response, the Department of Public Health’s responsibilities and budget increased dramatically during the COVID-19 pandemic. The CDPH budgets for 2022 and 2023 more than quadrupled the department’s pre-pandemic allocation, driven primarily by federal grants including $151 million each year in American Rescue Plan funds.
In the proposed 2024 budget CDPH appropriates $133.8 million from the Coronavirus Local Fiscal Recovery Fund, down from the previous years but still the department’s second-largest funding source, following the CDC’s Building Epidemiology and Health IT Capacity grants.
Prior to the pandemic, the department’s budget had averaged a 2011-2020 growth rate of 1.8% per year. Departmental budgets overall increased an average of 1.5% per year over the same time period, while the total city budget including Finance General appropriations grew at an average rate of 4.5% annually.
The department’s pre-pandemic budgeted workforce shrank at a rate of roughly -3.8% annually from 2011-2020. Overall budgeted positions for the city remained relatively flat across the same time periods, with minor year-to-year fluctuations averaging out to an overall growth rate of -0.002%.
Staffing
Total headcount is up a net 70 full-time positions and FTEs, one of the largest net staffing increases in the 2024 budget proposal.
The increase is largely driven by the addition of nursing and clinical staff positions across a number of titles. All told, CDPH’s budget adds 43 nursing positions (including four psychiatric nurse practitioners), 19 mental health crisis clinicians, and 12 clinical therapists.
The largest staffing reductions came in the department’s epidemiology and infectious disease related positions, including the elimination of 22 communicable disease investigator positions (including one regional investigator position) and 12 epidemiologist positions.
Appropriations
Largest Appropriations
Despite a 20.5% reduction from the previous year, the $518.6 million professional and technical services (outside contracting) appropriation is still CDPH’s largest by far in the 2024 proposed budget, making up more than half the departmental budget.
Pass-throughs to delegate agencies are the next-largest appropriation, another 15.9% of total departmental appropriations at $141.3 million. The delegate agencies appropriation is up 18.3% from the previous year’s budget.
In addition to personnel and supply costs, CDPH’s largest appropriations in the proposed 2024 budget also include $23.7m in unspecified “indirect costs,” $14.5m for violence reduction programming, and $2.8m for reproductive health services.
Change from Previous Year
The decline in CDPH’s budget is almost entirely due to a $133.8m reduction in outside contracting under the professional and technical services appropriations. All other appropriations either saw minor reductions, remained the same, or increased, including a substantial $21.8m increase in delegate agencies pass-through spending.
The reduction in professional and technical services appropriations for CDPH primarily came from reductions in Coronavirus Local Fiscal Recovery funding and CDC infrastructure/capacity grants.
