Medicaid On The Brink: For Medical Centers, The Time To Prepare Is Now
Across the nation, healthcare leaders are bracing for one of the most dramatic overhauls to Medicaid in decades. For those of us running community-based health centers, the stakes could not be higher.
At Southern California Medical Center (SCMC), a Federally Qualified Health Center (FQHC) serving over 150,000 patient visits annually across eight clinics, we are on the front lines of the Medicaid transformation. The federal budget reconciliation bill moving through Congress, paired with California's preliminary budget, threatens to pull the rug out from under millions of patients and the providers who care for them.
The proposed federal legislation includes sweeping changes: new work requirements for Medicaid eligibility, cuts to provider payments and reductions in federal match rates. In California, the preliminary budget takes it a step further by eliminating Prop 56 supplemental payments, capping overtime and travel hours for in-home supportive services (IHSS) and freezing enrollment for undocumented adults.
These aren't abstract policy shifts. They are real, dangerous changes that would limit access to care for countless individuals who rely on community-based health centers for everything from prenatal care to chronic disease management. They would eliminate our reimbursement for serving undocumented patients. They would force us to make impossible decisions about staffing, services and scope. And the ripple effects would be devastating—not just for our clinics, but for our state's economy, schools and hospitals.
Getting Ahead Of It
We are proactively taking steps now in anticipation of these proposals potentially becoming law. Fellow healthcare leaders looking for ideas on how to prepare can consider the following actions:
1. Educate patients. We've launched targeted outreach to help patients understand how these policy changes could affect their coverage and what steps they can take to stay enrolled. This is about preserving trust in a time of fear and uncertainty.
2. Conduct financial modeling. We're analyzing how reduced PPS reimbursements, cost-sharing shifts and premium impositions might impact our budget and service lines. Every dollar lost in reimbursement is a service denied to someone who needs it most.
3. Adjust operations. We're revisiting workflows and provider capacity models to stay nimble if demand increases from displaced patients elsewhere.
4. Address broader impact. In 2022, California was home to 1.8 million unauthorized immigrants. Many of these individuals rely on FQHCs like ours for essential preventive care. If these individuals lose access, the result will likely be a surge in ER visits for conditions that should have been treated earlier—and far more affordably—in a clinic setting. This is a looming education and economic disaster. The majority of children we serve attend inner-city public schools. If their parents lose access to care, it will compromise the health, attendance and stability of these students. That's a direct hit to educational outcomes and to the state's long-term financial stability.
5. Advocate. We're actively working with Community Clinic Association of Los Angeles County (CCALAC) and the California Primary Care Association (CPCA) while also meeting regularly with local, state and federal government officials. The message is clear: Politics have no place in deciding who deserves healthcare. Healthcare leaders cannot stand by while harmful provisions dismantle the safety net our communities rely on.
6. Promote internal resilience. We're prioritizing staff training and mental health supports to prepare our team for the emotional toll of doing more with less. Burnout is a real threat to continuity of care, and healthcare leaders must guard against it.
Prepare Now—And Make Your Voice Heard
The reality is: Healthcare cannot become a casualty of political theater. Denying care to low-income families and undocumented residents is not a solution—it's a setup for systemic collapse. Emergency rooms will be inundated. Public schools will be strained. Communities will suffer.
As we face these potential changes, I urge fellow healthcare leaders to prepare now. Audit your patient base, run financial simulations, strengthen community partnerships and invest in advocacy infrastructure. Stay engaged, stay responsive and, most importantly, stay vocal.
At SCMC, our mission is rooted in equity. While these policies may reshape the healthcare landscape, they only deepen our resolve to adapt, advocate and act in the best interest of our patients and community. Whether it's at the statehouse, in budget meetings or in exam rooms, we will continue to fight for our patients.
Healthcare shouldn't be a political casualty. It should be a promise we keep—especially to those who need it most.
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