About 1,500 federally funded well being facilities that serve tens of millions of low-income folks face important monetary challenges, their leaders say, as the federal government shutdown compounds different cuts to their income.
A few of these neighborhood well being facilities could have to chop medical and administrative workers or cut back companies. Some might finally shut. The end result, their advocates warn, could also be added stress on already crowded hospital emergency rooms.
“That is the worst time in all of the years I’ve been working in well being care,” mentioned Jim Mangia, president and CEO of St. John’s Group Well being, a community of 28 clinics that serves greater than 144,000 sufferers in Los Angeles, Riverside, and San Bernardino counties in California. “We face federal cuts and excessive state cuts that may impression companies.”
St. John’s and different federally certified well being facilities provide major care and a variety of different companies freed from cost or on a sliding charge scale. Nationwide, they see practically 34 million sufferers within the nation’s most underserved areas.
The federal funds come via two major routes, each of which face challenges: grants paid partly via the federal Group Well being Middle Fund and reimbursements for sufferers’ care via packages like Medicaid, which offers medical health insurance for low-income folks and folks with disabilities. Medicaid is collectively funded by states and the federal authorities.
Congress has accredited the grant cash in dribs and drabs not too long ago. 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 via a multiyear fund.
The facilities obtained $4.4 billion in grants in early 2024. The Nationwide Affiliation of Group Well being Facilities is advocating for no less than $5.8 billion in grants yearly for 2 years to maintain the facilities absolutely practical.
The well being middle security web faces “a number of layers of challenges,” mentioned Vacheria Keys, vp of coverage and regulatory affairs for the affiliation.
The brand new spending legislation that Republicans name the “One Large Stunning Invoice Act” will considerably lower Medicaid, elevating the second set of threats for well being facilities.
Medicaid accounted for 43% of the $46.7 billion in well being middle income in 2023.
Advocates mentioned decrease Medicaid funds will exacerbate a niche between funding and operational prices.
Funding for workforce packages additionally is required to assist the supply of well being care companies as facilities wrestle to rent and retain employees, mentioned Feygele Jacobs, director of the Geiger Gibson Program in Group Well being at George Washington College.
The first clinics of this sort opened in locations reminiscent of Massachusetts within the Nineteen Sixties. Congress usually has funded them with bipartisan assist, with minor fluctuations.
The wrestle this yr started when the Trump administration froze home help via a January memo, which prevented some facilities from receiving already accredited grant cash. As a consequence, some well being facilities in states reminiscent of 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 embody necessities for Medicaid enrollees to report their work or different service hours to maintain their advantages.
In the meantime, extra beneficiant tax credit the Biden administration and Congress offered customers to assist pay for Inexpensive Care Act medical health insurance are set to run out on the finish of the yr. Some customers’ prices will spike if Congress doesn’t renew them.
One purpose the federal government shut down is that Democrats wish to prolong the tax credit, which shield customers from greater insurance coverage prices. The Republican funding invoice didn’t embody an extension; Republican congressional leaders say the problem needs to be addressed individually.
Customers “will want extra assist than ever,” mentioned Jacobs, noting that Medicaid cuts and the expiration of the upper tax credit will each “probably throw folks out of protection.”
Ninety % of the facilities’ sufferers have incomes which can be twice the federal poverty stage or much less, and 40% are Hispanic.
“We’re additionally receiving 300 calls per day from sufferers involved about their protection,” mentioned Mangia, from St. John’s.
Republicans are usually not immediately focusing on the facilities, though they supported the Medicaid cuts that may have an effect on the clinics’ funds. Many Republicans say Medicaid spending has ballooned and that lowering this system’s progress will make it extra sustainable.
State and Native Help
Whereas advocating for longer-term federal funding, the facilities additionally need to their neighborhood 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 assist for the well being facilities.
The query is how lengthy the cash will final.
Whereas some states boosted their assist of the facilities, others are stepping into the wrong way. Anticipating the impression of Medicaid cuts, states reminiscent of California made their very own cuts to this system.
California Gov. Gavin Newsom’s workplace, the federal Division of Well being and Human Providers, and the federal Well being Assets and Providers Administration didn’t reply to requests for remark.
In Los Angeles, Mangia mentioned, one potential answer is to work with companions on the county stage, noting that L.A. County has about 10 million residents.
“We are able to tax ourselves to extend funding for well being care companies,” he mentioned.
Well being middle leaders are constructing a coalition that “hopefully” will embody the primary stakeholders within the county’s well being care system — neighborhood well being facilities, clinics, hospitals, docs, well being plans, unions — to start the method to fill out a poll petition, Mangia mentioned. The purpose: Put the query about taxes for well being facilities on the poll and let voters determine.
“We’re studying that the federal authorities and the state authorities are usually not dependable in relation to persevering with to fund well being care,” Mangia mentioned.
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