Community health centers say they are often overlooked when people search for medical providers, even though they are open to everyone. But now they are worried health services could be severely reduced under the Trump administration.
"It brings down total cost of care"
Community health centers — also known as Federal Qualified Health Centers (FHQC) — have been around since the 1960s, created by the federal government as a safety net to help take care of underserved and vulnerable populations, regardless of their ability to pay.
Allison van der Velden runs the Community Health Center of Franklin County, one of 50 across Massachusetts and more than 1,200 around the country. She said these health centers have always had bipartisan support.
"For people who are motivated by social issues, (our care) is very impactful and effective," she said. "And then on the other hand, you actually see a decrease in health care expenses. It stimulates local economies. And it brings down total cost of care because you're adding prevention."
Van der Velden was giving a tour of their new Turners Falls location (one of three in western Mass., including Greenfield and Orange), with high ceilings, a light-filled waiting room and well-equipped exam rooms.
Unlike many other medical practices in this rural area, she said they are taking new primary care patients and hoping to expand.
"We have room to grow," she said. "We're only using half the building right now."
When people hear the term "community health center," van der Velden said, they assume it’s only for people with low incomes, but in fact anyone can come. Many centers provide mental healthcare and dental services and have staff to address housing and other social services that impact health.
Van der Velden says the very existence of community health centers takes pressure off the healthcare system as a whole, like reducing unnecessary ER visits.
"We have better quality outcomes," she said. "We have better supports for patients who are struggling to navigate through a referral to a specialist."
"It really did scare us"
But all of this feels precarious right now because community health centers may be caught in the Trump administration’s crosshairs on several fronts.
For one, all community health centers rely on a core federal grant, which was temporarily suspended in February by the Trump administration.
Although the grant was reinstated, van der Velden said, "it did really scare us because we haven't ever had that before."
Adding to worry, the federal agency that has always administered that grant is now undergoing major layoffs and being absorbed into the newly restructured federal health department.
Van der Velden says the core federal grant accounts for 15 percent of her center’s budget. The rest comes from health insurance payments, and that leads to an even greater worry. About half of their 9,000 patients rely on Medicaid, which is currently on the federal government’s chopping block.
"Medicaid is about a third of the average health center's revenue," said Shade Cronan, of the Massachusetts League of Community Health Centers. "So if there are any changes to that Medicaid program, that's going to have a significant financial impact on our health centers."
MassHealth cuts could devastate health centers
The Massachusetts League of Community Health Centers is tracking the threats that could come from federal healthcare cuts. In Massachusetts, Medicaid goes by the name MassHealth. If it’s cut, Cronan said, it’s unlikely the state could make up the difference.
"And then health centers will have to make really difficult decisions, potentially to reduce services, to close sites, to lay off staff," she said.
The league is calling on Massachusetts’ Democratic congressional delegation to advocate hard for Medicaid and other federal grants that go to community health centers.
"If folks don't have their local health centers to go to, they're going to end up in the emergency departments," she said.
Not only is that bad for individual health, she said, but it's likely to clog urgent care options for everyone.
Advocacy and contingency planning
In the meantime, Cronan said health centers are operating amid confusion and uncertainty.
"They are all busy contingency planning — 'what will happen if x percent of our revenue is cut because there's a change to Medicaid?'" she asked.
Cronan said community health centers are also worried that future grant funding will be tied to restricting who they treat, such as undocumented workers or people needing gender-affirming care.
And van der Velden said the very mission of health centers — to treat everyone who comes in the door — is being questioned by executive orders against diversity and equity.
"In order to meet one expectation, we must violate the other," she said.
But for now, van der Velden said they are carrying on as usual and hoping anyone who needs will the care come get it.
