Mayor Daniel Lurie announced Wednesday that he has chosen Mike Levine, who runs Massachusetts’ Medicaid program, to lead the San Francisco Department of Homelessness and Supportive Housing, a move intended to deepen the city’s integration of health care and homelessness services. Levine will succeed Shireen McSpadden, who has said she will retire effective June 30 after about five years overseeing the department.
Levine arrives with experience managing large public health systems. As Massachusetts’ Medicaid director he oversaw a $23 billion program providing care for roughly 2 million people, including more than 10,000 individuals experiencing homelessness. In San Francisco he will head one of the city’s largest departments, with an annual budget of about $785 million, and be tasked with translating health-driven approaches into street-level reductions in homelessness.
Lurie framed the hire as a continuation of a strategy that brings homelessness and health work closer together. “Mike is an expert in connecting health care and homelessness services, and he has seen the power of integrating primary care, behavioral health, and social supports to keep people housed,” Lurie said, adding that the administration has already begun aligning those systems under his leadership. The mayor has made the issue a central priority while also confronting an increasingly constrained city budget.
Levine signaled a similar approach in his own statement, saying homelessness “is more than a housing issue” and that stabilization requires addressing addiction and mental health. He described work in Massachusetts to “retool” Medicaid so that health and homeless service providers coordinate more effectively and so that the state rewards providers who engage the hardest-to-serve clients. Supporters in Boston spoke highly of him: Dr. Jim O’Connell, president of Boston Health Care for the Homeless, called Levine “a brilliant leader” who can bring together legislators, hospitals, shelters and community clinics.
Not everyone greeted the pick without reservation. Jennifer Friedenbach, executive director of the local nonprofit Coalition on Homelessness, said Levine’s public-sector track record is useful but noted he appears to have limited direct experience working with frontline homeless service providers. “Hopefully we can work with him to bring him up to speed,” she said. The Homelessness Oversight Commission recommended Levine’s appointment on Tuesday; commissioners said he was the only candidate considered. Commissioner Sharky Laguana pointed to Levine’s extensive resume and a “strong working relationship” with the city’s public health director, Daniel Tsai, another Lurie appointee with Medicaid experience.
Levine steps in as the city wrestles with mixed data and new methodologies for counting people without stable housing. San Francisco recorded a 7% increase in its overall homeless population, including shelter residents, between 2022 and 2024; a fresh count conducted in January is due to be released this summer but officials warn the new methodology will limit direct comparisons to prior years. The new director will also be charged with continuing efforts to reduce visible tent encampments and implementing programs aimed at discouraging long-term RV dwelling — all while navigating fiscal pressures that could affect service delivery.