Hawaiʻi's rural healthcare at stake as federal funding freezes

Yahoo

30-01-2025

WAILUKU, Hawaii (KHON2) — The freezing of federal funds has thrown many nonprofit organizations in Hawaiʻi, especially those providing healthcare services, into a state of uncertainty.
Amongst these organizations is the Maui AIDS Foundation (MAF), which serves some of the most vulnerable populations in Maui.Linda Puppolo, executive director of the MAF, is deeply concerned about the potential consequences of this funding freeze.
'We serve the most vulnerable people of Maui. We do syringe exchange, food pantries, healthcare enrollment, STI testing and more,' Puppolo explained. 'Many of our clients would qualify for Medicaid if we didn't provide these services for free.'
The foundation's wide-ranging services reach individuals who would otherwise fall through the cracks of the formal healthcare system.
Many clients fear being exposed in other healthcare settings due to stigma, which makes MAF's discreet, nonjudgmental environment crucial.
'We have quite a lot of clients who are terrified right now because they feel like they'll be exposed anywhere else,' Puppolo shared, highlighting the personal stakes involved.
The foundation's operating budget exceeds $2 million, but a significant portion of that funding comes from federal sources. Some grants are directly administered, while others flow through state agencies.
One of the most at-risk programs is the housing subsidy for people living with HIV. And Puppolo fears the worst: 'We believe the HUD housing grant is on the chopping block,' she said. 'That's over $1 million of our money for housing subsidies right there.'
In addition to housing, MAF runs a host of other programs like hepatitis outreach, medical care for incarcerated individuals and a free clinic for STI testing. If funding is cut, these vital services are at risk of being discontinued.
'If they take away the housing, we would have to lay off several people,' Puppolo explained. 'We have 16 staff members; and if the grants that subsidize their salaries are eliminated, that's a huge impact.'
One of the major federal funding sources MAF depends on is the Ryan White program, which supports healthcare for people living with HIV. 'Ryan White funding is a big part of what we do,' Puppolo said. 'It helps with things like dental care, which regular Medicaid won't cover.'
However, even this funding is in jeopardy, as it is also subject to the same uncertain future. 'We don't know if Ryan White funding will continue,' Puppolo added as she reflected the widespread anxiety nonprofits like MAF face.
In addition to the financial strain, Puppolo expressed frustration with the lack of transparency surrounding these funding cuts.
'There's a gag order on federal employees, and we can't get any straight answers,' she said. This lack of clarity complicates planning and makes it difficult for organizations like MAF to prepare for what's ahead.
'We're not even sure if we can still access reimbursements,' Puppolo remarked. 'We've had to check ourselves to see if we can still download the money we're owed.'
For MAF, the financial uncertainty could be disastrous.
'If we lose our 501(c)(3) status, all our grants are gone,' Puppolo warned. 'The foundation has worked hard for 37 years to build a solid reputation, and now it's all at risk.'
This is particularly concerning given MAF's long-term investments, which includes the mortgage on their building.
'We've worked together with other organizations to build this space, and it was always with the idea that we would be here for the long term. But how can we fund a home if we don't have any funding?' Puppolo asked.
The situation is especially dire for rural communities like Maui, which already face significant challenges in accessing healthcare.
'We're considered a Medically Underserved Area, and now they're talking about defunding rural healthcare entirely,' Puppolo said. 'How do you do an HIV test when you don't even have the funds to keep the clinic open?'
The implications are vast and touch everything from basic medical services to the availability of housing and food support for vulnerable populations.
Despite these grave concerns, Puppolo remains committed to doing everything she can to advocate for the community.
'We don't know what the future holds, but we're going to keep pushing for our clients,' she said. 'We've built something special here, and we're not going to let it go without a fight.'
In the broader context, nonprofits across the state are feeling similar pressure. The Maui AIDS Foundation's budget alone is a window into the challenges these organizations face: the freezing of federal funds would have devastating consequences for services like food pantries, behavioral health programs and housing support.
Puppolo emphasized the vital role MAF plays in the local community as she explained that many of their clients have nowhere else to turn.
MAF's ability to support a diverse range of services that includes insurance enrollment assistance has also been at the heart of its outreach efforts. Between October and December 2024, MAF assisted 173 individuals with Medicaid enrollment and another 64 with Medicare enrollment.
These numbers reflect the demand for comprehensive healthcare support on Maui, and Puppolo's team continues to work tirelessly to meet this need despite the funding uncertainty.
But the future remains unclear, and Puppolo is not alone in feeling the weight of this uncertainty.
'Everything is up in the air, and it's all very scary,' she said.
The freezing of federal funds could lead to significant cutbacks in essential services. The ripple effects of this policy could mean increased hardship for individuals and families already grappling with health and economic challenges in one of the most isolated parts of the U.S.
Linda Puppolo, along with other leaders of rural nonprofits, is working to secure the resources necessary to continue providing life-saving services.
However, the decision of federal policymakers will ultimately determine the fate of these crucial programs and the thousands of people they serve.
You can click here for more information on MAF.
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As Puppolo put it, 'If they take it all away, we'll be left with nothing, and so will the people who depend on us.'
At 12:49 p.m. HST Pres. Trump's Press Secretary, Karoline Leavitt, released a statement that claims:
HOAX: A score of Fake News outlets … claimed President Trump's directive to temporarily pause certain federal spending was 'rescinded.'
FACT: No such thing took place. Instead, a memo from the Office of Management and Budget was rescinded in an effort to alleviate confusion — and Press Secretary Karoline Leavitt confirmed President Trump's order remains 'in full force and effect, and will be rigorously implemented' as the administration works to root out waste, fraud, and abuse.
— United States White House
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