On any given day, the SoMa Rise sobering center temporarily offers the comforts of housing to the homeless. Day after day, people living on the streets shake off their addictions to fentanyl or alcohol just long enough to amble through SoMa Rise’s front door on Howard Street. There they receive the basics — a bed, a shower, a meal — and sometimes more, including referrals to treatment.
For Mayor Daniel Lurie, the 4-year-old program has become a model for how to help San Francisco’s most desperate. It has also become an emblem of how to pay for such services.
One year after Lurie announced Breaking the Cycle, his signature strategy to combat homelessness, addiction, and mental health issues, the city is changing the way it bills for some homeless services to mirror its fiscal success with SoMa Rise. Under changes ordered by Lurie, the Department of Public Health is billing more programs to CalAIM, a Medi-Cal program, instead of charging the city directly.
Jonathan Salevao, a health worker, makes a bed at SoMa RISE, a detox and addiction treatment center. | Source: Morgan Ellis/The Standard
Medical supplies, including acetaminophen and antacid tablets, are supplied at the intake station at SoMa RISE. | Source: Morgan Ellis/The Standard
That change has saved the city $11 million in the last year. If an initiative to expand CalAIM billing to more programs is successful, it may free up hundreds of millions of dollars in San Francisco’s budget each year, according to Public Health Director Dan Tsai.
“That is a huge amount that otherwise would have had to have been fully funded through general fund dollars,” he said.
The services of around 31 other nonprofits may soon be billed to CalAIM. City officials are “turning over every stone” to identify more public health programs that can be funded this way, Tsai said.
The strategy is helping to alleviate twin crises for San Francisco’s public health infrastructure: the city’s $877 million budget deficit and potentially hundreds of millions of dollars in federal Medicare cuts.
One year in, many of the initiatives in Lurie’s Breaking the Cycle program mirror the new billing scheme — producing structural changes that may take time to fully realize. But others of the mayor’s roughly 20 distinct proposals within the program remain stymied.
By analyzing city data on homelessness, addiction, and treatment outcomes, The Standard endeavored to highlight Lurie’s successes and challenges with Breaking the Cycle.
The verdict: Street homelessness is visibly less of a problem, paying for it has become easier, and street teams are reaching people in need more quickly. But when it comes to getting them permanently housed, there’s still a steep hill to climb.
Lurie’s most obvious success on homelessness is one you can see: There are fewer tents on San Francisco’s streets. The number is even more stark if you consider where we were in 2022, when more than 500 tents and similar structures were counted.
Breaking the Cycle marshaled San Francisco’s nine disparate homelessness street teams, stretched across multiple city departments, under one banner at the Department of Emergency Management.
The city’s response is more coordinated — and faster.
Quicker response times improve the overall effectiveness of the Department of Homelessness and Supportive Housing, according to its director, Shireen McSpadden. “Obviously, the shorter this can be, the better for the client, and also the better for the cost of the system,” she said at a March 6 Homelessness Oversight Commission meeting.
But the street teams are hobbled by a lack of shelters that can accept homeless people. And other beds have been “taken offline,” meaning they’re no longer being used.
Ahsing solutions lead ambassador Kareem Washington directs his crew during a street cleaning operation at Wiese Street in San Francisco, Tuesday, Oct. 28, 2025. | Source: Manuel Orbegozo for The Standard
Lurie notably failed to hit his campaign promise of creating 1,500 shelter beds, pivoting his messaging to vowing to build the “right” kind of beds, like the 2025 expansion of sober-specific and stabilization beds at Eleonora Fagan Center and the Salvation Army Harbor Light Center in SoMa, Hope House on Sixth Street, and Wells Place in the Marina.
Crisis stabilization beds at 822 Geary, which opened (opens in new tab) in April 2025, provide an avenue for people who otherwise wouldn’t find shelter, said Vitka Eisen, director of Healthright 360, a major health provider in the city.
“There are people who come into our central access intake who are just really not regulated. We don’t believe that they would be safe,” Eisen said. “Now we have a place to send them.”
Still, others wait.
San Francisco’s shelter waiting list remains a pernicious issue. When a person seeking assistance approaches a nonprofit or city agency, their information is entered into myriad databases that don’t communicate with one another.
Reforming that system was one of the goals Lurie committed to within a year of launching Breaking the Cycle, and a pilot program to unify those client systems is ongoing. Meanwhile, an effort to encourage cities across the region to do more to take care of their own homeless populations — so they don’t come to San Francisco — has yet to bear fruit, though the mayor’s office said there is “active outreach.”
The persistence of family homelessness in San Francisco continues to rankle advocates and civic leaders. Former Homelessness Oversight Commission member Christin Evans called out Lurie’s program at a March 6 meeting.
“The challenge with Breaking the Cycle is that if you look at all of the details in there, it’s not family-centric or senior-centric,” Evans said, referring to so-called “invisible” sources of homelessness, where people sleep in cars or couch-surf. “It’s very much focused on visible homelessness.”
Tipping Point, the anti-poverty group founded by Lurie, committed $11 million (opens in new tab) toward a family homelessness prevention pilot program last year. While seniors haven’t been a focus of Breaking the Cycle, Lurie took heat from the southeast community by opening Jerrold Commons, a homeless shelter focused on seniors and people living in RVs.
Perhaps the most promising statistics are those related to the administration of buprenorphine, an anti-opioid hailed as a breakthrough in addressing fentanyl addiction. There were 624 accidental overdose-related deaths in 2025 (opens in new tab), according to the medical examiner’s office. That’s nine fewer than in 2024 and well below 2023’s high of 810.
While Breaking the Cycle is complex, its main thrust is reforming homelessness efforts to better integrate healthcare, said Kunal Modi, the mayor’s policy chief on homelessness.
“One of the challenges San Francisco has had over the past decade was we took a very ‘social service only’ lens to what is a crisis that is much broader than that,” Modi said. “The primary thesis is that we need to approach this fundamentally as a healthcare problem.”
That healthcare-centric approach is what enables the city to bill CalAIM for more services.
The number of people who have exited homelessness into city-supported housing this year is down. However, at the Homelessness Oversight Commission’s March meeting, McSpadden said she believes the city is still on track to meet its five-year goal to take 30,000 people out of homelessness.
Empty beds, including ones low to the ground to accommodate clients with mobility issues, at SoMa RISE. | Source: Morgan Ellis/The Standard
Progress in housing people living in RVs parked in the city’s southern neighborhoods has also faced challenges. Under Lurie’s large-vehicle program, the city bought back 49 vehicles, and 71 households moved out of vehicles into housing or shelter. There are still hundreds of people living among roughly 300 vehicles, which were granted permits exempting them from the new two-hour parking limit.
Homeless advocates have criticized Breaking the Cycle for prioritizing temporary shelter over permanent housing.
Homelessness Oversight Commission member Sharky Laguana argued that permanent housing is expensive, and it makes more financial sense to heal people through sobering and other treatment centers, as Lurie is trying to do, rather than a housing-first strategy.
“We’re in a situation where we made a commitment to a policy choice that if we don’t make some changes in how we’re moving forward, there simply won’t be money left for anything else,” Laguana said.
As part of last year’s budget, Lurie negotiated with the Board of Supervisors to siphon $34 million from a fund focused on housing toward bolstering the shelter system. It’s a fundamental difference in philosophy: Breaking the Cycle concentrates on healthcare and shelters as the primary levers of alleviating homelessness.
Many advocates, on the other hand, believe the chief way to end homelessness is to give people homes.