As the federal government shutdown enters its second week, leaders of community health centers in North Texas are worried of the far-reaching consequences for patients and clinics.
Community health centers are a part of the health care “safety net." They provide a wide range of services to underserved populations utilizing different sources of funding and revenue, including from the federal government.
Dr. John Carlo, CEO of Prism Health North Texas, said so far, this shutdown appears no different than the several Prism Health has survived in the past.
“The basic sort of things that we look at is whether or not the people, the government employees, that we work with every day, whether they are available,” he said. “Whether they're able to reach out and we're able have engagement and get what we need in terms of services.”
But he’s a little more concerned about this shutdown compared to previous ones. As existing government funders send out notices, clinics have to identify any critical areas being affected.
During the shutdown, non-essential federal employees are furloughed, which can already cause a problem for clinics. But, Carlo said community health center leaders are worried this won’t just be a temporary loss of those federal employees.
“What gives us alarm is ... perhaps this is not just a furlough, or time away,” he said. “These may be positions [they’re] eliminating and things like that. That's a very different situation.”
Prism Health is a Federally Qualified Health Center, or FQHC, Look-A-Like — which function close to how FQHCs do. FQHCs are community-based health care providers that have certain compliance requirements to receive federal grants and specialized funding under Medicaid and Medicare.
Medicaid and Medicare payments shouldn’t be effected by the shutdown, unlike some other social service programs, but there may be some delay in administrative functions – especially if the shutdown goes on for an extended period of time.
“Are they staffed well enough so that they can reimburse us for the services that we're delivering today?” Carlo said. “So far, we're seeing everything work as normal, but that is the one area where we worry that could be delayed.”
How long before the shutdown causes issues?
LBU Community Clinics is an FQHC also based in NOrth Texas. CEO Leonor Marquez said about 30% of the organization's overall funding comes from the federal government. While LBU locations are operating business as usual, Marquez said she's a little worried about being able to maintain that as the government shutdown continues.
"A prolonged shutdown compromises our ability to sustain care," Marquez said. "So far, we haven't had any trouble...But what will happen a month or two months down the road? It's a little worrisome to know that we don't have the same support at the federal government. And by that, I mean the people that ... could troubleshoot if something goes wrong."
Marquez said she's concerned about what a shutdown could mean for the long-term sustainability of her FQHC and others across the Texas and the country.
"What we need is at least level funding to allow us to continue to provide the care for the thousands of patients that we see just here at LBU Community Clinic," she said.
If the time between when clinics provide services and when they get reimbursed grows too much, clinics may not have the resources.
"If that turns into a week or two weeks, that's a concern because we don't have that kind of reserve that can sustain," Marquez said.
The FQHC model doesn’t allow organizations to use federal funding to create reserves, meaning they often don’t have a lot of funding to rely on while funding is held up. If payments get delayed, Carlo said it can also be difficult to get the funding restored once the shutdown is over.
“We’re already stretched thin just in terms of how the financing works overall,” Carlo said. “When you start thinking about the duration [of the shutdown], that starts to play into how long can you sustain an organization and continue to provide the services and employ the staff that are providing those services.”
While a longer shutdown creates more concerns, Carlo said there’s not a particular duration that creates a greater risk.
“There's no sort of a period I can tolerate versus I cannot because there's too many variables to that,” he said. “The shorter the better. Any prolonged situation is going to stretch us further and it's going to cause us to have to think about making changes in terms of what services we can deliver.”
Disruptions can have long-term consequences
Changes or adjustments to services could reverse some of the progress made in north Texas. Carlo said some Prism Health patients take a “high degree of effort” to get them to come into a clinic. Things like additional assistance, transportation and community outreach take a lot of resources.
“Almost every time you have a shutdown or disrupt care, you're essentially starting all over,” Carlo said. “It takes a great deal of planning and commitment through community relationships that can be disrupted in a single move with a shutdown that it takes years to recover.”
Carlo said the people who get hurt the most are patients. FQHCs increase capacity and provide depth and range of services, which Carlo said other health care providers can’t effectively replace.
FQHCs provide access to care for people enrolled in Medicaid, people without insurance and people who may not be able to afford care elsewhere. Because Medicaid reimbursements are typically much lower than reimbursements from private insurance plans, Carlo said private practices and even some primary care providers in hospitals don’t accept Medicaid.
The most immediate effect to those patients is losing access to critical care that can prevent chronic conditions and maintain the overall health of the community.
“If we start losing funding for these resources, it comes pretty quick to not having slots available for these patients,” Carlo said. “What that looks like on the day-to-day basis is waiting lists for primary care visits, less behavioral health services available.”
LBU Community Clinic saw about 26,000 patients in 2024, and more than half of its patients are uninsured.
CEO Leonor Marquez said losing community health centers could result in people not engaging in critical preventive services. She said people will go without care, and utilize the emergency room more — which can raise health care costs and put more strain on those services.
"People will die if they don't get the preventive care," Marquez said. "People will die prematurely if they don't get the preventive that they need to keep them healthy."
Uncertainty could prevent much needed growth
Marquez said this isn't the first or only time FQHCs have had to deal with challenges thrown their way.
"Being an FQHC is an ongoing exercise in trying to plan for a future that is uncertain," she said.
LBU has been able pivot while dealing with past situations that could have a substantial impact on their funding. Marquez said the organization will not compromise the quality of care it offers patients, but fewer resources means fewer people are able to access care — and that's something all FQHCs have to deal with.
Prism Health serves about 18,000 patients each year, with a focus on the LGBTQIA community in Dallas. It has five health clinics, two dental clinics and three pharmacies. It’s one of almost 80 FQHC and FQHC look-a-likes across Texas.
It’s in the process of expanding access critical services in North Texas. Carlo said weathering a government shutdown could get in the way of that.
“While we may sort of not see a reduction, our desire was to grow,” Carlo said. “Growth in these kinds of uncertain times becomes extremely difficult.”
The government shutdown isn’t the only source of uncertainty and instability the health care industry is facing right now. Under the massive new budget bill, there are major changes to Medicaid and Medicare that could influence how much funding FQHCs get.
In addition, the Affordable Care Act enhanced premium tax credit is set to expire in December – and is one of the main things federal lawmakers are disagreeing about. In Texas, changes to the ACA are estimated to result in 1.3 million people becoming uninsured as premiums increase.
"Fewer people will be able to afford their health insurance, which will turn an insured patient who is able to get care into someone who is uninsured and may not go to the doctor as often as they need to," Marquez said.
She said she's concerned that as people lose coverage, they may not know what services are available to them.
However, that also means more people may end up depending on community health centers — even as they're stretched even thinner, said Carlo with Prism Health.
“Community health centers across the country operate in razor thin margins have been able to weather these challenging times,” Carlo said. “That's what we do very, very well as health centers, but these are unprecedented times.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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