Paula Andalo
About 1,500 federally funded well being facilities that serve hundreds of thousands of low-income individuals face important monetary challenges, their leaders say, as the federal government shutdown compounds different cuts to their income.
Some of those group well being facilities could have to chop medical and administrative employees or cut back companies. Some may ultimately shut. The end result, their advocates warn, could also be added stress on already crowded hospital emergency rooms.
“This is the worst time in all the years I have been working in health care,” stated Jim Mangia, president and CEO of St. John’s Community Health, a community of 28 clinics that serves greater than 144,000 sufferers in Los Angeles, Riverside, and San Bernardino counties in California. “We are facing federal cuts and extreme state cuts that will impact services.”
St. John’s and different federally certified well being facilities supply major care and a variety of different companies freed from cost or on a sliding payment scale. Nationwide, they see nearly 34 million patients within the nation’s most underserved areas.
The federal funds come by way of two major routes, each of which face challenges: grants paid partially by way of the federal Community Health Center Fund and reimbursements for sufferers’ care by way of packages like Medicaid, which offers medical insurance for low-income individuals and folks with disabilities. Medicaid is collectively funded by states and the federal authorities.
Congress has permitted the grant cash in dribs and drabs just lately. In March, lawmakers prolonged the funds till Sept. 30. That cash expired after the Republican-controlled Congress didn’t move a funding legislation, resulting in a authorities shutdown.
Advocates say the well being facilities want long-term funding to assist them plan with extra certainty, ideally by way of a multiyear fund.
The centers obtained $4.4 billion in grants in early 2024. The National Association of Community Health Centers is advocating for at least $5.8 billion in grants yearly for 2 years to maintain the facilities absolutely practical.
The well being heart security web faces “multiple layers of challenges,” stated Vacheria Keys, vp of coverage and regulatory affairs for the affiliation.
The new spending law that Republicans name the “One Big Beautiful Bill Act” will considerably minimize Medicaid, elevating the second set of threats for well being facilities.
Medicaid accounted for 43% of the $46.7 billion in well being heart income in 2023.
Advocates stated decrease Medicaid funds will exacerbate a spot between funding and operational prices.
Funding for workforce packages additionally is required to help the supply of well being care companies as facilities battle to rent and retain employees, stated Feygele Jacobs, director of the Geiger Gibson Program in Community Health at George Washington University.
The first clinics of this kind opened in locations akin to Massachusetts within the Nineteen Sixties. Congress usually has funded them with bipartisan help, with minor fluctuations.
The battle this yr started when the Trump administration froze domestic aid by way of a January memo, which prevented some facilities from receiving already permitted grant cash. As a consequence, some well being facilities in states akin to Virginia closed or merged operations.
The upcoming cuts are also set to reach at a time when sufferers will face new calls for and challenges. The Medicaid modifications in President Donald Trump’s tax-and-spending legislation embrace necessities for Medicaid enrollees to report their work or different service hours to maintain their advantages.
Meanwhile, more generous tax credits the Biden administration and Congress offered customers to assist pay for Affordable Care Act medical insurance are set to run out on the finish of the yr. Some customers’ prices will spike if Congress doesn’t renew them.
One cause the federal government shut down is that Democrats wish to lengthen the tax credit, which shield customers from larger insurance coverage prices. The Republican funding invoice didn’t embrace an extension; Republican congressional leaders say the difficulty needs to be addressed individually.
Consumers “will need more support than ever,” stated Jacobs, noting that Medicaid cuts and the expiration of the upper tax credit will each “potentially throw people out of coverage.”
Ninety p.c of the facilities’ sufferers have incomes which can be twice the federal poverty level or much less, and 40% are Hispanic.
“We are also receiving 300 calls per day from patients concerned about their coverage,” stated Mangia, from St. John’s.
Republicans should not immediately concentrating on the facilities, though they supported the Medicaid cuts that can have an effect on the clinics’ funds. Many Republicans say Medicaid spending has ballooned and that lowering this system’s development will make it extra sustainable.
State and Local Support
While advocating for longer-term federal funding, the facilities additionally wish to their group and native governments for backing.
Some states already took motion whereas finalizing their annual budgets. Connecticut, Minnesota, Illinois, and Massachusetts allotted cash for facilities. Maryland, Oregon, and Wisconsin additionally offered help for the well being facilities.
The query is how lengthy the cash will final.
While some states boosted their help of the facilities, others are entering into the other way. Anticipating the impression of Medicaid cuts, states akin to California made their own cuts to this system.
California Gov. Gavin Newsom’s workplace, the federal Department of Health and Human Services, and the federal Health Resources and Services Administration didn’t reply to requests for remark.
In Los Angeles, Mangia stated, one potential answer is to work with companions on the county degree, noting that L.A. County has about 10 million residents.
“We can tax ourselves to increase funding for health care services,” he stated.
Health heart leaders are constructing a coalition that “hopefully” will embrace the primary stakeholders within the county’s well being care system — group well being facilities, clinics, hospitals, medical doctors, well being plans, unions — to start the method to fill out a poll petition, Mangia stated. The aim: Put the query about taxes for well being facilities on the poll and let voters determine.
“We are learning that the federal government and the state government are not reliable when it comes to continuing to fund health care,” Mangia stated.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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