San Francisco workers are staring down a quiet health care deadline that could cost them a serious chunk of change. The city is prepared to sweep roughly $240 million in unused worker healthcare money into the general fund unless account owners take action by May 21. The balances sit in employer contributed Medical Reimbursement Accounts, run through the City Option program, which workers can use for out of pocket medical and wellness expenses. Department of Public Health officials say accounts that go three years without activity are eligible to be closed and their balances transferred to the City Treasury.
According to reporting by The San Francisco Standard, about $240 million tied to inactive SF City Option accounts will revert to the city's coffers unless owners enroll or file a claim by 5 PM on May 21. The Standard reports that the sweep follows a Health Commission policy change adopted in 2022 that allows unclaimed worker funds to escheat to the general fund.
How the City Option Works
The City Option program is one way employers comply with San Francisco's Health Care Security Ordinance by depositing mandated health spending into an SF Medical Reimbursement Account (SF MRA) for eligible workers. According to the San Francisco City Option, the program has received about $1.9 billion in contributions since 2008 and has connected roughly 457,000 unique employees to MRAs, with employers contributing $215 million for about 79,000 workers in fiscal 2023–24.
How To Keep Your Account Active
To prevent account closure, the city says workers must take at least one of several actions at least once every three years, such as enrolling in an SF MRA, submitting a claim or receiving a new employer contribution, which resets the inactivity clock. The City of San Francisco publishes a searchable list of inactive account holders and directs people to verify accounts via the SF City Option portal or by calling customer service at 1 (877) 772‑0415.
What You Can Spend It On
SF MRA funds cover a broad range of reimbursable health costs, not just hospital bills. The program's eligible expenses guide lists hundreds of items, from dental care and eyeglasses to breast pumps and lactation supplies, wheelchairs and crutches, wart removal treatments, COVID‑19 tests and many common prescription and over the counter purchases, and it explains when a provider statement is required; see SF City Option for details.
Labor And Business Reaction
Labor leaders say the money belongs to workers and warn against treating it as a budget windfall. "The funds should be provided for healthcare and applied to working people’s healthcare," San Francisco Labor Council President Mike Casey told The San Francisco Standard, while some business groups have criticized the City Option's design and complained the mandate burdens small employers, as reported by Gazetteer SF.
Legal And Budget Angle
The Health Commission approved the escheatment mechanism in 2022, instructing the Department of Public Health and city financial offices to move inactive SFCO funds to the City Treasury after three years of inactivity, according to a DPH memo. The potential sweep has fiscal weight as San Francisco confronts an estimated two-year budget gap of roughly $643 million, a shortfall noted in recent budget reporting and city documents.
If you have worked in San Francisco and think you might have an SF MRA, the city is urging you to use the City's funds finder tools, enroll or file a claim to preserve any balance. Outreach and mailings are underway in multiple languages, and local reporting notes that accounts can be claimed even by people who have moved out of the region. The city's contact line and online enrollment remain the official routes to protect balances ahead of the May 21 deadline.
