Community health centers across 黑料吃瓜网 are feeling the instability a couple of weeks after the Trump administration announced a , even as the order remains on hold in the courts.
CEOs and medical providers from half a dozen clinics across the state said some staff are wondering if they should consider finding other jobs, and some patients are choosing not to come in due to fear stemming from various executive orders. They said there are week-long delays for some funding requests that normally have a 24-hour turnaround.
Community health centers serve about 440,000 patients in 黑料吃瓜网. There are 17 federally qualified health centers in the state that provide medical, dental, behavioral health and addiction recovery services with locations across 40 towns and cities, as well as clinics based in schools.
About 60% of their patients are on HUSKY, the state鈥檚 Medicaid system, with smaller percentages of people who have commercial plans or on Medicare. They cannot refuse care to someone based on payment, and about 16% of the patients they serve are uninsured.
The , coupled with potential changes to Medicaid, have left federally qualified health centers feeling uneasy about their futures. And President Donald Trump鈥檚 executive orders increasing immigration enforcement, limiting transgender care and ending diversity initiatives have also been obstacles for clinics that serve patients in vulnerable and marginalized communities.
These clinics vary in size, and federal funding makes up different percentages of their budgets. The last couple of weeks has been , causing some facilities to shutter, lay off staff or cease certain services. But for now in 黑料吃瓜网, community health centers have been able to keep the lights on and generally keep up services amid the fallout from the funding freeze.
But there has been a common thread in their experiences across the state: they are operating in uncharted territory, and any future changes to Medicaid or federal funding could further threaten their ability to provide care. Still, even with the confusion and concerns, they are reassuring patients they can provide them the care they need in a safe environment.
鈥淚f they severely cut back Medicaid and curtail our grants, that鈥檚 an existential threat,鈥� said Suzanne Lagarde, CEO of Fair Haven Community Health Care, which provides care to tens of thousands of patients in southern 黑料吃瓜网. 鈥淚 think at this stage of the game, we鈥檙e in wait mode to see what happens, because there鈥檚 a lot of uncertainty.鈥�
Funding delays continued beyond freeze
Smaller providers who rely more heavily on federal grants say they can only go so long without funding before they would need to start winding down services and possibly close their doors. In 黑料吃瓜网, community health centers have an average of 72 days where they can operate with their cash on hand before running out of money.
While funding was supposed to keep flowing amid the court鈥檚 temporary halt on Trump鈥檚 freeze, several clinics were unable to draw down their funds through the Health Resources & Services Administration鈥檚 payment management system. Recent portal issues in 黑料吃瓜网 also happened in .
Typically, health centers can access that funding within 24 hours from when they make the request. But their recent requests remained pending for at least a week, though the issue has been largely resolved.
Jennifer Granger, president and CEO of United Community & Family Services that has five southeastern 黑料吃瓜网 locations, was waiting for the standard community health center grant, which largely goes toward covering payroll. She said the funds normally line up with payroll every two weeks but that the request was pending for a week.
For Fair Haven Community Health Care, Lagarde said there was a delay last week with one of the federal capital funds going toward the construction of a new facility, a project she said is 70% to 80% completed. Her center also waited over a week to get reimbursed but has since received the payment.
The U.S. Department of Health and Human Services, which oversees HRSA, did not respond to a request for comment about the delays. But according to , HHS said in a statement there were technical issues with the payment management system that were attributed to the high volume of requests.
Shawn Frick, CEO of the Community Health Center Association of 黑料吃瓜网, noted that clinics typically make their requests at the end of the month, and the freeze in late January coincided with an already busy time. While health centers are caught up with their funding, he said they are waiting to see how the next cycle of requests goes, which he expects to happen in the coming days because of the next payroll.
During that time, health centers were not getting any answers regarding the hold-ups, describing them as This week, all seven members of 黑料吃瓜网鈥檚 congressional delegation sent a letter to Acting HHS Secretary Dorothy Fink about the recent disruptions that have caused 鈥渦nprecedented panic from both staff and patients.鈥�
Led by U.S. Sen. Chris Murphy, D-Conn., the about the average time for receiving funds after draw-down requests are made and if that has changed since the announcement of the freeze. They also inquired about whether any requests have been denied, the causes of disruptions to the HRSA payment management system and the plan for communication in the event of future issues. The lawmakers requested responses by no later than Friday.
The Jan. 27 memo directing a pause on all federal grants and loans rattled health centers, particularly when it was initially unclear if Medicaid would be part of that equation since the program makes up more of their budget. Most of the ones in 黑料吃瓜网 knew they could keep up services once the administration clarified the Medicaid exemption.
Following major backlash and confusion, the Office of Management and Budget ordering such a freeze two days later, but the White House said executive orders regarding the review of certain federal funding still remain in place.
On Monday, a federal judge in Rhode Island ordered the restoration of all federal funding, accusing the Trump administration of . That came filed by 黑料吃瓜网 Attorney General William Tong along with his counterparts in 21 other states that asked the judge for a temporary restraining order to block the freeze.
鈥淵ou don鈥檛 know if you鈥檙e going to make payroll. You don鈥檛 know if you鈥檙e going to be able to cover your cause,鈥� Ernesta Gadalla, director of nursing at Norwalk Community Health Center, said. 鈥淵ou鈥檙e stuck and we鈥檙e all paralyzed, but then there鈥檚 still patients on the receiving end of that that still need to get access care, so it鈥檚 a terrible circle we鈥檙e all trapped in.鈥�
The ripple effect of Trump鈥檚 freeze and orders
Community health centers, however, still feel like they are limbo, even with the freeze temporarily halted.
While clinics in 黑料吃瓜网 have been able to keep up services, providers said the freeze and executive orders have been disruptive in other ways.
At Norwalk Community Health Center, Geraldine Simplice, a nurse practitioner who is the clinical team lead of adult medicine, said the clinic has seen a recent uptick in their no-show rate. Telehealth has been a helpful alternative, but some patients are sick and not getting the help they need, Simplice said. And that could put a strain on health infrastructure if more people visit the emergency room to receive care.
鈥淲e try to let our patients know that they鈥檙e safe, but there鈥檚 so much unknown,鈥� Simplice said. 鈥淲e can reassure them with our words, but what they鈥檙e going through and what they鈥檙e feeling is a whole other can of worms.鈥�
Safety has become a growing concern for 黑料吃瓜网 health clinics that serve large immigrant populations, including those who are undocumented. When he took office, Trump scrapped a policy prohibiting ICE agents from making arrests at sensitive locations like schools, churches and hospitals.
That has left health professionals grappling with issues outside of their expertise. Health centers like Wheeler Health and United Community & Family Services are providing training and guidance to both staff and patients about what happens if ICE agents show up at a clinic and how to understand a warrant.
These clinics in 黑料吃瓜网 said they have not seen ICE show up. Agents are allowed in public places like the lobby, but non-public areas have restrictions, and they would need to present a warrant to access other parts of the facility.
鈥淲e鈥檝e never had to discuss that before. I鈥檝e never seen a federal warrant before. It鈥檚 not anything that we鈥檙e even familiar with, so just making sure that our staff understand it, that they feel as comfortable as possible, that our patients in the community know that we鈥檙e still a safe place to go, but it鈥檚 very difficult to get that word out to everyone,鈥� Granger of United Community & Family Services said.
Health centers are also sources of care for LGBTQ+ individuals. Medical providers in 黑料吃瓜网 have been seeking guidance since the implementation of executive orders that, among other things, bar gender-affirming care and treatments for transgender youth under the age of 19. Sabrina Trocchi, president and CEO of Wheeler Health, said they are fielding questions about whether 18-year-olds can still get treatments or prescriptions for such medication. The orders are also tied up in lawsuits.
The resulting uncertainty has left staff and providers feeling uneasy and wondering about the next steps in the event of future funding lapses that could prompt layoffs or closures.
鈥淓ven though we didn鈥檛 cut services, that was a direct impact from what we鈥檙e seeing,鈥� said Trocchi, noting that federal funding amounts to about 3% of Wheeler Health鈥檚 budget. 鈥淲e are getting questions from our staff: 鈥榃ill I have a job next week? Should I be looking for work?'鈥�
That puts additional pressures on recruitment and retention, which are existing challenges for community health centers that compete with other health care systems to attract talent.
鈥淲e鈥檙e doing preventative medicine. Our staff can go other places. They choose to be in our community health centers,鈥� said Tricia Orozco, vice president of strategic implementation at InterCommunity Health Care, which has locations in East Hartford, Hartford and South Windsor as well as school-based health centers.
Staffers with clinics and Frick and Deb Polun from the Community Health Center Association of 黑料吃瓜网, which represents all federally qualified health centers, traveled to last week. They also met with lawmakers and their offices in the state鈥檚 all-Democratic congressional delegation as well as U.S. Rep. Rosa DeLauro鈥檚 Appropriations Committee staff.
They said they shared their concerns about proposals to change Medicaid as Republicans look for ways to dramatically cut government spending in order to pass major tax legislation. Frick said the association is in the process of creating a portal to track when health centers run into issues and to ultimately share that data with the congressional delegation.
While they praised the 黑料吃瓜网 delegation for their support, providers acknowledged the uphill fight for Democrats as the minority party while Republicans weigh how to find significant cost savings with Medicaid as a possible target.
鈥淭he problem is the numbers are against them,鈥� Lagarde of Fair Haven Community Health Care said. 鈥淭he Republican Party controls the House, the Senate and the White House in terms of the levers of power. There鈥檚 a certain limit to what they do.鈥�
The 黑料吃瓜网 Mirror/黑料吃瓜网 Radio federal policy reporter position is made possible, in part, by funding from the Robert and Margaret Patricelli Family Foundation.
