SF's New Homelessness Czar Comes From Massachusetts

Mayor Daniel Lurie has tapped a Massachusetts Medicaid official to lead San Francisco’s Department of Homelessness and Supportive Housing, filling a seat that will be vacant when current director Shireen McSpadden steps down in June.

Lurie announced Wednesday that Mike Levine, who currently heads Massachusetts’ Medicaid program, will take over the department. The Homelessness Oversight Commission recommended Levine for the role following McSpadden’s announcement last month that she was leaving the position.

“Mike is a lifelong public servant, having led Massachusetts’ Medicaid program, a $23 billion agency that serves nearly 2 million residents,” Lurie said in a statement. “He is an expert in connecting health care and homelessness services, and he has seen the power of integrating primary care, treatment, and social supports to keep people healthy and housed. That’s the experience we need in San Francisco.”

The hire follows a pattern Lurie established early in his tenure. This is the second appointment he has made out of the Massachusetts Medicaid office. The first was Daniel Tsai, who now leads the city’s Department of Public Health. Tsai spent six years running Massachusetts’ Medicaid program before serving as President Joe Biden’s chief of the national Medicaid program at the Centers for Medicare and Medicaid Services. That Lurie is returning to the same office for another senior appointment signals a deliberate philosophy: bring in administrators who know how to move large amounts of health care money and connect it to social services.

Levine walks into the job at a precarious moment. San Francisco is waiting on results from its latest biennial homeless point-in-time count, conducted in late January, with results expected in the coming weeks. The count will offer a public benchmark for how the city’s homelessness efforts are actually tracking. The department almost certainly already knows what those numbers show, and the timing of McSpadden’s departure has raised questions about what the data reveals.

Lurie, for his part, pushed forward with an upbeat framing Wednesday. Tent encampment numbers have “hit the lowest level we’ve recorded,” he said, adding that more people are accepting shelter offers under the city’s new street teams model and that more residents are getting treatment for fentanyl addiction. Whether those claims hold up against the point-in-time count figures, once released, will tell a clearer story about where the city actually stands.

The reasons behind McSpadden’s decision to step down remain unclear. She announced last month she would leave in June, but no public explanation has been offered for the timing. City Hall has not addressed the circumstances directly.

Levine’s background is rooted in health care financing rather than street-level homelessness services. That approach mirrors how Lurie has framed the problem: not as a social services failure alone, but as a health care and housing integration challenge. Lurie said Levine “understands how to maximize state and federal funding at a time when cuts are coming and every city dollar matters.” That last point is not a throwaway line. Federal funding for social services is under active pressure, and San Francisco, like other cities, is watching Washington for signals about what programs survive the current budget environment.

From a neighborhood perspective, that funding question matters enormously. The department’s work touches everything from Navigation Centers to permanent supportive housing placements to the staffing of street response teams. Any cuts to federal Medicaid or housing support programs would land directly on the people those services are meant to help, and on the neighborhoods where they live.

Levine will need to move fast. He arrives as the point-in-time count results drop, as federal budget uncertainty continues, and as a new street teams model is still being tested. San Francisco has cycled through homelessness leadership before without the needle moving much. The question for Levine is whether importing a health care systems approach to a city with complicated, deeply political homelessness dynamics will produce something different.

McSpadden’s last day is in June. The transition timeline is tight, and the count results will set the terms of the conversation Levine walks into from day one.