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About 1,500 federally-funded well being facilities that serve thousands and thousands of low-income individuals 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 cut back companies. Some might finally shut. The end result, their advocates warn, could also be added strain on already crowded hospital emergency rooms.
“This is the worst time in all the years I have been working in health 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 are facing federal cuts and extreme state cuts that will impact services.”
St. John’s and different federally certified well being facilities provide main care and a variety of different companies freed from cost or on a sliding payment scale. Nationwide, they see practically 34 million sufferers within the nation’s most underserved areas.
The federal funds come by two main routes, each of which face challenges: grants paid partly by the federal Group Well being Heart Fund and reimbursements for sufferers’ care by packages like Medicaid, which gives medical insurance for low-income individuals and other people 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 go 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 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 a minimum of $5.8 billion in grants yearly for 2 years to maintain the facilities totally practical.
The well being heart security web faces “multiple layers of challenges,” mentioned Vacheria Keys, vice chairman of coverage and regulatory affairs for the affiliation.
The brand new spending legislation that Republicans name the “One Big Beautiful Bill 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 heart 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 help the supply of well being care companies as facilities wrestle to rent and retain staff, mentioned Feygele Jacobs, director of the Geiger Gibson Program in Group Well being at George Washington College.
The primary clinics of this kind opened in locations akin to Massachusetts within the Nineteen Sixties. Congress sometimes has funded them with bipartisan help, with minor fluctuations.
The wrestle this 12 months started when the Trump administration froze home help by 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 additionally 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.
In the meantime, extra beneficiant tax credit the Biden administration and Congress supplied shoppers to assist pay for Inexpensive Care Act medical insurance are set to run out on the finish of the 12 months. Some shoppers’ prices will spike if Congress does not renew them.
One cause the federal government shut down is that Democrats need to prolong the tax credit, which shield shoppers from larger insurance coverage prices. The Republican funding invoice didn’t embrace an extension; Republican congressional leaders say the problem ought to be addressed individually.
Shoppers “will need more support than ever,” mentioned Jacobs, noting that Medicaid cuts and the expiration of the upper tax credit will each “potentially throw people out of coverage.”
Ninety % of the facilities’ sufferers have incomes which can be twice the federal poverty degree or much less, and 40% are Hispanic.
“We are also receiving 300 calls per day from patients concerned about their coverage,” mentioned Mangia, from St. John’s.
Republicans aren’t 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 decreasing this system’s development will make it extra sustainable.
State and native help
Whereas advocating for longer-term federal funding, the facilities are additionally trying to their group and native governments for backing.
Some states have already taken motion whereas finalizing their annual budgets. Connecticut, Minnesota, Illinois, and Massachusetts allotted cash for facilities. Maryland, Oregon, and Wisconsin additionally supplied 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 into the wrong way. Anticipating the impression of Medicaid cuts, states akin to California made their very own cuts to this system.
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 can tax ourselves to increase funding for health care services,” 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, docs, well being plans, unions—to start the method to fill out a poll petition, Mangia mentioned. 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 mentioned.
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Well being facilities face dangers as authorities funding lapses (2025, October 7)
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