Community health centers in western Massachusetts and around the country are taking steps to prepare for billions of dollars of health care cuts just passed by Congress.
They expect the changes to strain the health of both patients and health care organizations.
The most immediate threat is the almost $1 trillion cut ($940 billion) in Medicaid funding.
President Trump’s budget bill, which was passed by Congress in early July, will roll out the Medicaid cuts in stages, starting January 2026. That means fewer people will be eligible for care.
“We are preparing because the work is about to get harder – by a lot,” said Allison van der Velden, who runs the Community Health Center of Franklin County.
She says almost half their budget comes from Medicaid reimbursement. She estimates the cuts will reduce the rural center’s $20 million budget by about $1 million. So they are focusing on intense efficiency.
“Just to make sure that our providers are busy,” she said, “and being really on top of all of our billing processes to make sure any dollars that we're entitled to, that we that we actually get paid.”
They are making greater use of tele-health to avoid missed appointments and looking to a newly opened pharmacy for revenue, van der Velden said. The goal is to enter this new era of uncertainty with a financial cushion.
“We will see more patients who present for care who can't pay for it," she said. "When folks lose their insurance, they don't stop getting sick."
“Looking at cutting back on services”
Like all community health centers, Franklin County’s gets a core federal grant – about $2.5 million a year. Van der Velden says that grant is not on the budget chopping block yet.
But while there was about $50 billion in the federal budget bill set aside for rural health care, she said that’s not enough to make up for almost twenty times that much in cuts across the country.
So now, for the first time, the health center is looking for charity.
“We are starting to build out philanthropy and fundraising,” she said, “because we don't know exactly how big the gaps will be but we are expecting them to be significant.”
The Franklin County community health center is actually in a better position than many others, van der Velden said, because it has a higher proportion of Medicare patients – older and disabled people who don’t rely on Medicaid.
Nevertheless, she said, “if we're not able to fill the gap….we would be looking at cutting back on services, laying off staff or closing down sites.”
Meanwhile, it’s likely MassHealth, which is the Massachusetts version of Medicaid, will start to cover fewer services and procedures, since the state won’t be getting federal reimbursement at nearly the same level. And next year – after the midterm elections – the Connector health plans from the Affordable Care Act will get more expensive, pricing many middle-income people out of insurance.
The Trump administration also just took away a provision from almost 30 years ago that allowed health centers to care for undocumented immigrants – a change being challenged in the courts by Massachusetts and 20 other states.
Van der Velden says that’s created a lot of confusion over how health centers will serve all their patients without breaking the federal rules.
“It’s sort of an ingrained part of our mission that we do not turn anybody away, which is aligned with public health goals,” she said, “because it's very hard to have a healthy community when a portion of it does not have access to care.”
And she pointed out another new concern since news came out that the federal agency in charge of both Medicaid and Medicare is now sharing patient information with ICE. Van der Velden said this threatens the trust between patients and the health center and could stop undocumented people from coming in for care or even applying for Medicaid.
“Much harder than the Covid pandemic”
As a result of all these stressors, experts warn that emergency rooms are likely to fill up with people who are no longer getting basic, preventative health care.
When van der Velden tries to predict how this next period could go, she thinks about the pandemic. Covid was a severe outside threat, but at least health providers got relief from the government, she pointed out. This time, the financial crisis is originating from the government, so there’s no backstop.
“This will be much harder than the Covid pandemic,” she said. “It's going to have a bigger impact and there isn't going to be relief available.”
At the same time, she warned there could still be another pandemic, or regional threats like natural disasters, as well as worsening preventable diseases since fewer people will get care.
And while the center hasn’t made any cuts yet, they just don’t know how long this funding drain will continue. Four years? A decade?
“If this is 10 years of insufficient funding and no other funding comes in,” she said, “then it's going to be a shell of a health center by the end of it.”
What gives van der Velden hope, she said, is the collaborative spirit of Franklin County and the many nonprofits and charitable organizations in western Mass that will try to help make up for what the government is no longer providing.
