About 1,500 federally funded well being facilities that serve thousands and thousands of low-income folks face important monetary challenges, their leaders say, because the authorities shutdown compounds different cuts to their income.
A few of these group well being facilities might have to chop medical and administrative workers or cut back companies. Some might ultimately shut. The consequence, 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 influence companies.”
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 charge scale. Nationwide, they see almost 34 million sufferers within the nation’s most underserved areas.
Jackie Fortiér/KFF Well being Information
The federal funds come by means of two major routes, each of which face challenges: grants paid partially by means of the federal Group Well being Middle Fund and reimbursements for sufferers’ care by means of applications like Medicaid, which offers medical 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 lately. In March, lawmakers prolonged the funds till Sept. 30. That cash expired after the Republican-controlled Congress didn’t cross 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 means of 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 at the least $5.8 billion in grants yearly for 2 years to maintain the facilities absolutely practical.
The well being heart security internet 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 Lovely Invoice Act” will considerably reduce 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 mentioned decrease Medicaid funds will exacerbate a niche between funding and operational prices.
Funding for workforce applications additionally is required to help the supply of well being care companies as facilities battle 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 kind opened in locations akin to Massachusetts within the Sixties. Congress sometimes has funded them with bipartisan help, with minor fluctuations.
The battle this yr started when the Trump administration froze home help by means of a January memo, which prevented some facilities from receiving already accredited 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 Trump’s tax-and-spending legislation embrace 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 shoppers to assist pay for Reasonably priced Care Act medical insurance are set to run out on the finish of the yr. Some shoppers’ prices will spike if Congress does not renew them.
One purpose the federal government shut down is that Democrats need to prolong the tax credit, which shield shoppers from greater insurance coverage prices. The Republican funding invoice didn’t embrace an extension; Republican congressional leaders say the difficulty ought to be addressed individually.
Customers “will want extra help 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 p.c of the facilities’ sufferers have incomes which might be twice the federal poverty degree 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 will not be straight concentrating 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 want 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.
Whereas some states boosted their help of the facilities, others are entering into the wrong way. Anticipating the influence of Medicaid cuts, states akin to California made their very own cuts to this system.
California Gov. Gavin Newsom’s workplace, the federal Division of Well being and Human Companies, and the federal Well being Sources and Companies Administration didn’t reply to requests for remark.
In Los Angeles, Mangia mentioned, one potential answer is to work with companions on the county degree, 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 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 mentioned. The purpose: Put the query about taxes for well being facilities on the poll and let voters resolve.
“We’re studying that the federal authorities and the state authorities will not be dependable in relation to persevering with to fund well being care,” Mangia mentioned.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.
