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Colleen Chawla is settling into an important role for San Mateo County: as its chief health officer who manages 2,200 employees and a $1.3 billion budget.
Chawla began in February, overlapping with her predecessor — Louise Rogers — for six weeks of training. Rogers served in the role for a decade. In her retirement, Rogers plans to spend more time with family, draw and travel to places like Yellowstone National Park, according to the county. Rogers and Chawla navigated many of the challenges of the COVID-19 pandemic together as Bay Area health directors, Rogers said.
“She was consistently calm and thoughtful in the face of everything coming our way,” said Rogers of Chawla. “She also seems to find grace and a sense of humor, as so often is needed.”
Chawla served as Alameda County Health’s director from 2017 to 2025. She moved to the Bay Area in 1999 to work for the San Francisco Department of Public Health where she served in leadership and legislative roles. She holds a master’s degree in public administration and health services administration from the University of San Francisco and a bachelor’s degree in history from the University of Southern California. She started her career in health at AIDS Project Los Angeles.
“She is pressure tested,” said San Mateo County Supervisor Ray Mueller, who served on the search committee, in a prepared statement. “She comes from a very challenging environment budget-wise, and at a time when every piece of health care is going to be under budget threat with federal support uncertain. To have someone like that here is incredibly important.”
County Health is charged with inspecting food handlers and restaurants, monitoring and responding to disease outbreaks, conducting vaccination programs, providing health care for vulnerable residents and responding to emergencies.
This news organization spoke with Chawla about her past work experience, priorities for the county and how she is addressing challenges like the bird flu and measles outbreaks.
Q: What are your top priorities as health chief?
A: Behavioral health is a significant priority. … There are a lot of state changes that are coming down as part of CalAIM (a multi-year project focused on reforming the state’s Medicaid system), and other state initiatives to improve behavioral health care for people with serious mental illness. … We’re in the process of implementing electronic health records. … One of the county’s top priorities is homelessness. … And then, federal changes in the landscape that are signaled, but not yet really happening (yet) … are on the radar too.
Q: Backing up a little bit with behavioral health care, what are some of the changes coming from the state?
A: We’re more than halfway through the implementation of the CalAIM changes, and one of the most significant ones around behavioral health is payment reform. It’s moving from cost-based reimbursement to fee-for-service reimbursement, meaning, the organization that we contract with had been paid based on the cost for running a program and will now be reimbursed a set amount for each client that they see. There’s been a lot of work with the community-based organizations that we contract with to implement that. But it’s not been without pain. It is coupled by the fact that a couple of our modalities of service have not gotten sufficient reimbursement rates from the state. Those two things have made it difficult for community-based providers (like StarVista).
And then other changes include something called SB 43, which changes (72-hour) involuntary commitment, 5150 rules. It expands them, and in one of the most significant ways it expands that to add substance use disorder to the range of conditions that can cause a person to be 5150. The system that we have in place is really about people with mental illness or (in) mental crisis, not substance use crisis; that network of services really didn’t exist already. You can’t just turn on the same system for people with different needs. … The implementation date for that is Jan. 1 of 2026.
Q: You mentioned that there have been signals of changes on the federal level. What are some of the things that could be coming up affecting the county?
A: There have been some things that happened already, but they’ve had very little impact on San Mateo County. The federal government has canceled a number of funding sources that … came from COVID-relief actions. … (Funding for) enhancing laboratory capacity, immunization, health disparities funding.
Fortunately, in San Mateo County, we spent those grants on the front end. … So the impact on us was very minimal. (In) other jurisdictions in California, that’s not the case. They tried to make that money last as long as the grant was eligible.
Q: Do you know how much money was left for COVID in the account here?
A: It was almost all gone, like less than $10,000.
And then the other things that are coming that were on the lookout for are changes to the Medicaid program. … It’s really too soon to know what they’re (federal officials) planning to do. We’re paying very, very close attention to what’s being discussed. It seems like what’s being discussed also changes quite quickly, so we’re waiting for a little bit more clarity on what path they might go down.
Q: Do you have concerns about how the changes to the Medicaid program will impact residents in San Mateo County?
A: We’re fortunate to be in San Mateo County and in California at a time like this. There is an ethos that is more supportive of everyone, regardless of economic status or documentation status. … But it doesn’t mean we’re immune. It could mean that people lose their health care coverage. … As a county health system, how do we support people to maintain access to health care services that they need? It could also mean reduced revenue for us for the services we provide already. The amount of that we’re not really able to estimate right now.
Q: What are some of the services that the county provides through Medicaid?
A: The services at San Mateo Medical Center in the hospital, in our clinics that are also part of the medical center, the behavioral health services that we provide. We run two managed care plans in our behavior health department that support people who are on Medi-Cal. One of the managed care plans is for people with severe mental illness, and the other is for people with substance use disorders. Those are funded by federal Medicaid dollars. There are some other programs elsewhere too, but those are the two main ones.
Q: What were some of the lessons you are bringing to San Mateo from your previous roles?
A: My role in Alameda was very similar to my role here. So it’s kind of nice to have some familiarity.
In San Francisco, the medical center is part of the health department. That’s not true in Alameda County. (In) my last seven years, I wasn’t working over the medical center in Alameda County.
I’m very familiar … with all of the behavioral health changes that I just mentioned.
Also in Alameda County, the health department was the lead on homelessness response. … Here the lead is really the human services agency. I feel like I am ready to be a good partner to the human services agency to help support people who are unhoused or unsheltered.
Q: I know that there’s been cases of bird flu and measles in the county. How are you sort of approaching these issues?
A: We’re definitely watching what’s happening, watching our neighbors, watching the statewide trends. We’ve only had one confirmed case of measles here back in February, and that was a person who had traveled internationally and was exposed in the country that they had traveled from. And there were no additional cases that stem from that one.
As far as H5N1 (bird flu) goes, the risk is still very low. We don’t have any major poultry or dairy farms in the county here, and no H5N1 has been detected in dairy cattle or humans in San Mateo County (it has been detected in backyard chickens). We continue to keep watch, but we are thankfully not heavily impacted here.
