About 1,500 federally funded well being facilities that serve hundreds of thousands 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 group well being facilities could have to chop medical and administrative workers or scale back providers. Some may finally shut. The outcome, 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,” stated 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 providers.”
St. John’s and different federally certified well being facilities provide major care and a variety of different providers freed from cost or on a sliding payment scale. Nationwide, they see almost 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 partially via the federal Group Well being Heart Fund and reimbursements for sufferers’ care via applications like Medicaid, which gives medical insurance for low-income folks and other people with disabilities. Medicaid is collectively funded by states and the federal authorities.
Congress has permitted 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 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 acquired $4.4 billion in grants in early 2024. The Nationwide Affiliation of Group Well being Facilities is advocating for not less than $5.8 billion in grants yearly for 2 years to maintain the facilities totally purposeful.
The well being middle security internet faces “a number of layers of challenges,” stated Vacheria Keys, vice chairman of coverage and regulatory affairs for the affiliation.
The brand new spending legislation that Republicans name the “One Massive Lovely Invoice 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 middle income in 2023.
Advocates stated decrease Medicaid funds will exacerbate a spot between funding and operational prices.
Funding for workforce applications additionally is required to help the supply of well being care providers as facilities wrestle to rent and retain employees, stated 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 resembling Massachusetts within the Sixties. Congress usually has funded them with bipartisan help, with minor fluctuations.
The wrestle this 12 months started when the Trump administration froze home assist via a January memo, which prevented some facilities from receiving already permitted grant cash. As a consequence, some well being facilities in states resembling 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 adjustments 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.
In the meantime, extra beneficiant tax credit the Biden administration and Congress offered customers to assist pay for Inexpensive Care Act medical insurance are set to run out on the finish of the 12 months. Some customers’ prices will spike if Congress doesn’t renew them.
One cause the federal government shut down is that Democrats wish to prolong the tax credit, which shield customers from increased insurance coverage prices. The Republican funding invoice didn’t embrace an extension; Republican congressional leaders say the problem must be addressed individually.
Customers “will want extra help than ever,” stated 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 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,” stated Mangia, from St. John’s.
Republicans are usually not instantly 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 decreasing 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 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 getting in the other way. Anticipating the impression of Medicaid cuts, states resembling 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 Assets and Companies Administration didn’t reply to requests for remark.
In Los Angeles, Mangia stated, one potential answer is to work with companions on the county stage, noting that L.A. County has about 10 million residents.
“We will tax ourselves to extend funding for well being care providers,” he stated.
Well being middle leaders are constructing a coalition that “hopefully” will embrace the principle stakeholders within the county’s well being care system — group well being facilities, clinics, hospitals, docs, 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’re studying that the federal authorities and the state authorities are usually not dependable in the case of persevering with to fund well being care,” Mangia stated.
