If you work in San Francisco, you may have an account stashed with thousands of dollars, waiting to be spent. 

The money, dispersed under a program called the SF City Option, can’t be used on just anything — it’s strictly for healthcare reimbursements. But that umbrella category covers more than 100 kinds of wellness (opens in new tab), including dental care, lactation pumps, wheelchairs, crutches, eyeglasses, wart-removal treatment, COVID-19 tests, and even some out-of-pocket healthcare fees. 

This is a use-it-or-lose-it situation, with less than a month left on the clock.

About $240 million of the fund has sat unclaimed for three years. If it isn’t claimed by San Franciscans by May 21, it’s goodbye to that free financial aid. The funds will legally transfer (the official term is “escheat” (opens in new tab)) to the city of San Francisco, giving Mayor Daniel Lurie a sizable sack of cash to bail out the city’s $643 million budget deficit.

Whether Lurie will use the funding to address this year’s shortfall is still being discussed, according to the mayor’s office. But last year, Lurie signaled that the money would be channeled toward a reserve created specifically to backfill federal cuts (opens in new tab).

Mike Casey, president of the San Francisco Labor Council, which represents city unions, said he would be disappointed to see the money used to plug the city’s budget gaps in other departments, such as public safety or housing. 

“We’ve said all along, and we have pretty close unanimity on this, that it should be provided for healthcare,” Casey said. The money was intended for workers, so it “should be applied to working people’s healthcare.”

The Board of Supervisors in 2006 passed the Health Care Security Ordinance, which requires San Francisco nonprofits with 50 or more workers, or businesses with 20 or more workers, to spend a prescribed amount (opens in new tab) on healthcare. One way they can do so is by contributing to the San Francisco City Option, which provides employee medical reimbursement accounts.

A worker’s available funds are tied to how much their employer contributed. While the city is set to yank some of that money in May — there’s still hundreds of millions available that isn’t set to expire soon —  you don’t need to have an immediate medical need to prevent the depletion of your account, according to the Department of Public Health. You just have to claim it. 

These are the ways to claim your funds:

“Closing accounts is the last resort as unclaimed or abandoned funds cannot be held in the (city option) program in perpetuity,” a Department of Public Health spokesperson said in a statement. The SF City Option program “wants individuals to leverage their accounts for the intended purpose, to provide coverage for health needs and emergencies.”

Still, there’s a growing need for healthcare-related city funding. President Donald Trump’s H.R. 1, also known as the One Big Beautiful Bill Act, may cause as many as 50,000 San Franciscans to lose access to Medi-Cal, with hundreds of millions of dollars in healthcare funding lost in the process.

DPH rolled out a social media blitz (opens in new tab) last year to drum up enrollments in City Option and started a debit card program to make it easier to use medical reimbursement accounts. The department did not provide data to show the results of the debit program.

While the pot of money may suggest this fund goes unused, more than 490,000 workers have claimed $1.83 billion in healthcare assistance from their accounts since the program’s inception. Just last year, the program disbursed an all-time high of more than $209 million. 

The data on specific types of usage is ambiguous, with half of all funds spent in a catch-all category going to “medical” expenses and a quarter of all funding used to reimburse dental care, according to DPH. San Franciscans over the last two years have used more than $40 million in reimbursements to pay for medication.

This will be the first time unused funds from the reimbursement accounts are rolled into the city’s general fund. The legal mechanism to do so was approved by the Health Commission in 2022, bringing the program in line with state law. 

Small-business owners have told The Standard the fees they contribute to the program are so high, it’s akin to doubling their rent. Insiders say meetings between key small-business stakeholders and labor to reform the program, while not curtailing its benefits, are ongoing.