Trump's Medicaid cuts deal a damaging blow to federally qualified health centers

Boston Globe

3 hours ago

Experts said federally qualified health centers were already on shaky financial ground, as the funding they receive for the care they provide
has not kept up with rising costs, such as personnel and medical technology.
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Trump's 'One Big Beautiful Bill' signed on July 4 includes
over the next 10 years. The new law is projected to cause
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'This kind of was the last straw,' Edward D. Shanshala, CEO of Ammonoosuc Community Health Services.
In New Hampshire, about
— receive health insurance through Medicaid.
In Massachusetts, about 300,000 people are at risk of losing their health coverage over the next decade, and the state stands to lose about $3.5 billion in funding,
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Shanshala said the health center
in Franconia, which serves about 1,400 patients, will shutter by year's end. He said Ammonoosuc Community Health will lose about $524,000 of its $11.5 million operating budget due to Medicaid cuts. Closing the Franconia location will save about $230,000, he said.
'It is all we can do at this time and a decision we are forced to make, not one we want to make,' he said in a letter to staff.
Franconia patients will be able to receive care at Ammonoosuc's locations in Whitefield or Littleton, 10 to 20 miles farther away for most patients,
according to Shanshala.
'What about people who have transportation barriers, who might walk to my office?' said Buddensee. 'I do have patients who do that, who can't drive or don't have a license or a vehicle.'
Buddensee said along with her patients, she's been saddened and disappointed about the closure.
The new federal law includes work requirements for some Medicaid recipients and increased reporting requirements for enrollments and renewals,
The Franconia health center isn't the only closure. Riverbend Community Mental Health announced in July it will close a supportive
'The things that are happening within the Medicaid world right now are very, very concerning and have the potential to really make it difficult for people to get the care they need,' said Lisa K. Madden, CEO of Riverbend.
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The Mascoma Community Health Center in Canaan, N.H.,
will close at the end of October because of
federal funding changes, issues with Medicaid reimbursement, high operating costs, and low patient volumes.
'Both the federal and state changes to Medicaid and the subsidies to the Affordable Care Act marketplace insurance played a big role in our decision to close,' said Ted Bolognani, CEO of HealthFirst, which has run the Canaan health center for about the last two years.
New Hampshire's new state budget contained
Georgia J. Maheras, senior vice president of policy and strategy at the Bi-State Primary Care Association, which covers New Hampshire and Vermont, said that since the pandemic health centers have been dealing with expenses rising faster than revenue.
'With that background, this legislation is very concerning ... it is likely that there would be additional site closures across northern New England and the country,' she said.
Modeling has indicated that about a third of patients on marketplace plans will lose insurance, while 10
percent to 25 percent of Medicaid beneficiaries could lose coverage, according to Maheras. That amounts to about
New Hampshire Senators Jeanne Shaheen and Maggie Hassan said they
expect about 46,000 New Hampshire residents to lose Medicaid. Another 10,000 could lose marketplace insurance, according to Shaheen.
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'In Franconia and Concord, Granite Staters are already beginning to see the devastating ways in which the Republican budget bill will hurt New Hampshire families and rip away access to health care — and sadly this is only the beginning,' Hassan said.
The New Hampshire Department of Health and Human Services is reviewing the impacts of state and federal legislation on the Medicaid program, spokesperson Jake Leon said. Leon did not respond to questions about the recent closures in New Hampshire or whether others are at risk of closing.
'While it may take some time to determine the full impact, the Department routinely communicates with Medicaid beneficiaries and providers and will continue to do so,' Leon wrote in an email.
Federally qualified health centers are required to see all patients, regardless of their ability to pay. That means uninsured patients can still receive care, but the health center is unable to charge insurance for their visit and instead charges a sliding fee as low as $5 to $10.
'It is a significant potential loss of revenue to the health center,' said Alison L. Croke, CEO of Wood River Health, a health center with three locations in Rhode Island
that she said stands to lose about $500,000 in revenue as a result of federal cuts.
The health center is barely breaking even as it is, even after laying off staff and freezing salaries last year, Croke said.
'Health centers are kind of teetering on the edge there, and so if we're pushed over that cliff with a
half a million dollar loss in revenue, there are some tough choices that we would need to make,' she said.
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For health centers with multiple locations, shuttering some centers is one way to reduce costs,
Croke said.
'Hospitals and pretty much every other provider are already under some strain in Rhode Island, and any sort of further reductions are going to further destabilize the system,' said Howard Dulude, interim president of the Hospital Association of Rhode Island.
He said federal cuts may disrupt services, staffing, and access to care. Hospital closures are a concern the organization is monitoring closely, he said.
Michael A. Curry, CEO of Massachusetts League of Community Health Centers, said about 47 percent of patients served by members of his organization are Medicaid recipients at risk of losing coverage.
'That's a significant threat to your financial model as a health center,' he said. He said the 52 health centers represented by his organization are committed to avoiding outright closures.
'With these Medicaid cuts, health centers will have to figure out a way to change their operations, to adjust to the loss of revenue, the disruption of access to Medicaid, and then figure out how to operate a health center without those resources,' Curry said. 'That's a daunting task for any business.'
Amanda Gokee can be reached at