Community health centers across Connecticut are feeling the instability a couple of weeks after the Trump administration announced a freeze on all federal funding, 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 Connecticut. 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’s 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 uncertainty surrounding federal funding, coupled with potential changes to Medicaid, have left federally qualified health centers feeling uneasy about their futures. And President Donald Trump’s 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 especially dire in other parts of country, causing some facilities to shutter, lay off staff or cease certain services. But for now in Connecticut, 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.
“If they severely cut back Medicaid and curtail our grants, that’s an existential threat,” said Suzanne Lagarde, CEO of Fair Haven Community Health Care, which provides care to tens of thousands of patients in southern Connecticut. “I think at this stage of the game, we’re in wait mode to see what happens, because there’s a lot of uncertainty.”
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 Connecticut, 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’s temporary halt on Trump’s freeze, several clinics were unable to draw down their funds through the Health Resources & Services Administration’s payment management system. Recent portal issues in Connecticut also happened in nearly a dozen other states.
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 Connecticut 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 media reports, 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 Connecticut, 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 “communication blackouts.” This week, all seven members of Connecticut’s congressional delegation sent a letter to Acting HHS Secretary Dorothy Fink about the recent disruptions that have caused “unprecedented panic from both staff and patients.”
Led by U.S. Sen. Chris Murphy, D-Conn., the delegation asked the agency 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 Connecticut knew they could keep up services once the administration clarified the Medicaid exemption.
Following major backlash and confusion, the Office of Management and Budget rescinded the memo 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 violating the court’s order. That came out of a lawsuit filed by Connecticut 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.
“You don’t know if you’re going to make payroll. You don’t know if you’re going to be able to cover your cause,” Ernesta Gadalla, director of nursing at Norwalk Community Health Center, said. “You’re stuck and we’re all paralyzed, but then there’s still patients on the receiving end of that that still need to get access care, so it’s a terrible circle we’re all trapped in.”
The ripple effect of Trump’s freeze and orders
Community health centers, however, still feel like they are limbo, even with the freeze temporarily halted.
While clinics in Connecticut 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.
“We try to let our patients know that they’re safe, but there’s so much unknown,” Simplice said. “We can reassure them with our words, but what they’re going through and what they’re feeling is a whole other can of worms.”
Safety has become a growing concern for Connecticut 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 Connecticut 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.
“We’ve never had to discuss that before. I’ve never seen a federal warrant before. It’s not anything that we’re 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’re still a safe place to go, but it’s very difficult to get that word out to everyone,” Granger of United Community & Family Services said.
Health centers are also sources of care for LGBTQ+ individuals. Medical providers in Connecticut 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.
“Even though we didn’t cut services, that was a direct impact from what we’re seeing,” said Trocchi, noting that federal funding amounts to about 3% of Wheeler Health’s budget. “We are getting questions from our staff: ‘Will I have a job next week? Should I be looking for work?'”
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.
“We’re doing preventative medicine. Our staff can go other places. They choose to be in our community health centers,” 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 Connecticut, which represents all federally qualified health centers, traveled to Washington, D.C., for a conference last week. They also met with lawmakers and their offices in the state’s all-Democratic congressional delegation as well as U.S. Rep. Rosa DeLauro’s 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 Connecticut 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.
“The problem is the numbers are against them,” Lagarde of Fair Haven Community Health Care said. “The Republican Party controls the House, the Senate and the White House in terms of the levers of power. There’s a certain limit to what they do.”
The Connecticut Mirror/Connecticut Public Radio federal policy reporter position is made possible, in part, by funding from the Robert and Margaret Patricelli Family Foundation.
This story was originally published by the Connecticut Mirror.
