Health centers brace for possibility of limited funds

Uncertainty continues after President Donald Trump's Office of Management and Budget rescinded its memo — but not the administration's plans — to freeze federal grant monies.

Charities, nonprofits and other organizations are facing unknown futures because funding they were approved to receive may not be available or reliable anymore. For some federally qualified health centers — primary, behavioral and oral health care clinics that operate on a sliding fee scale — their ability to stay open and provide health care services to their communities depends on federal grant money.

And in some parts of the state, federally qualified health centers are the only primary, oral or behavioral health care providers.

Marty Carty is the Oregon Primary Care Association's governmental affairs director. He said federally qualified health centers are different from hospitals or private clinics because they can't pass costs on to their patients or private insurers. Many patients of FQHCs don't have private health insurance; about 61% of FQHC patients in Oregon are covered by Medicaid, the federal health insurance program for people with lower incomes, and 15% are uninsured.

"Oregon FQHCs received $95,358,450 in federal base grant funding for fiscal year '24," Carty said. "A one-week pause of federal funds would have meant Oregon FQHCs would have had to cover $1,828,792 through other means — likely digging into limited reserve funds."

Nearly 471,800 Oregonians receive care from a federally qualified health center, according to data compiled by the Oregon Primary Care Association — that's about one in 10 people in the state.

Possible closures

Carty said if federal grants to federally qualified health centers stop, 30 centers in Oregon would be affected. The organizations rely on federal funding for payroll, rent and other costs to provide care. Some centers have enough cash on hand to cover a few months; others could only keep the doors open for 30 days.

Columbia River Health in Boardman is one of the lucky ones. CEO Sheila Corpus said the center could last for months if it loses grant funding, but she hopes that doesn't happen.

" Those funds are sacred to us," she said. "They're given to us to help people that don't have health care, that don't have a place to go, that need our help."

Corpus said while Columbia River Health isn't the only provider in Boardman, given the breadth of population they serve, if a freeze were to happen for long enough to force them to close, it would be "devastating" to the community.

A lot of federally qualified health centers withdraw their monthly grant awards at the start of each month, Carty said. If funding had paused for an extended period at the end of January into February, then, the centers wouldn't have had access to their monthly draw and would've had to rely on cash on hand.

Carty said the FQHC representatives he talked to in the aftermath of the freeze announcement had stopped any hiring, capital projects and investment plans. A disruption in the funds would have "a near-immediate impact" on communities across the state.

"Even though the memo was not implemented, it has led to a chilling effect among FQHCs and their staff, who in many cases have operating reserves of only 30 days," Carty said. "Even after a federal judge stayed the order, FQHCs and their staff are now forced to live in a world of uncertainty and fear."

Looking ahead

With the White House's announcement about the memo rescission, but keeping the review of federal spending directives, health care organizations are preparing for more uncertainty.

On Jan. 31, the Health Resources and Services Administration told grant recipients via email that "funds may not be used for activities that do not align" with Trump's executive orders about gender transitions or diversity, equity and inclusion.

"Any vestige, remnant or re-named piece of any programs in conflict with these E.O.s are terminated in whole or in part," the email said, though the notice was then rescinded Feb. 5.

According to an email from Portland-based FQHC electronic health record service provider OCHIN, the programs at risk include any "funding, sponsoring, promoting, assisting, or supporting gender transition care for individuals under 19 years of age," including puberty blockers, hormone therapy and gender-related surgeries.

Less funding in general also means more broadly that services without federal reimbursement might stop.

" What we heard across much of our membership was that anything that wasn't a reimbursable service would likely be one of the first things that they would cut," said Carty with the primary care association. " If you can only make two payrolls, you have to start making some tough choices pretty quickly."

At some health centers, for example, that could mean no more prescription deliveries to people who can't drive to the pharmacy themselves or no more food pantries available to patients.

Employees of the health centers are feeling the effects, too, Carty said, especially given the conflicted messaging from the government.

" FQHC staff are anxious and terrified and wondering if they're going to have their job tomorrow," he said. " Not only did the threat of a freeze impact the organization's decision making and operations, it also had a direct and visceral reaction from staff."

Carty said even with the rescission of the memo, the possibility of a freeze is hindering how the centers' CEOs are planning for the future.

"The answer that we can give them (about planning) is we don't know," he said. "What we do know and what we do believe, quite frankly, is that the administration will likely target the federally qualified health center program."