An eerie quiet and sense of fear has settled inside Massachusetts health care centers, clinics and some hospitals as administrators worry about whether their programs might be the next targets for federal cuts.
Some community health centers in Massachusetts had already taken steps to scrub language at odds with the Trump administration’s priorities, renaming programs and positions related to minimizing harms from drug use, reducing health disparities or providing transgender care.
But a change in federal grant rules has added new uncertainty about what services might trigger a grant cancellation notice. Employees don’t know what further precautions to take. Administrators are afraid to speak out.
“All the old rules are gone,” said one top health center administrator who requested anonymity for fear of being targeted by the federal government. “This is a much more dramatic threat.”
Alarm has been growing since last September when federal health officials spelled out their funding priorities. “Deprioritized” services included care for transgender youth and immigrants who entered the country illegally, and programs that promote racial equity and diversity.
In October, the U.S. Department of Health and Human Services asserted a legal right to terminate any grant that “no longer effectuates” its goals and priorities. Attorneys representing Head Start agencies, community health centers, addiction treatment programs, mental health services and other federal grant recipients are warning clients that cancellations could come at any time — with no explanation of which priorities were violated and with no option to appeal.
“All the old rules are gone. This is a much more dramatic threat.”
Health center administrator
When federal officials took steps to claw back some grants earlier this year, it cemented concerns that critical federal funding may be unstable.
“There’s a lot of fear and trepidation, trying to figure out as a community what we should do, ” said Edward Waters, the managing partner at Feldesman LLP, a Washington, D.C. law firm that specializes in federal grants for clients working in health care.
These federal awards fund care for many of the most vulnerable patients in Massachusetts. The state has 37 federally qualified health centers, designated through a federal grant program. Without that funding, many organization leaders said they would be unable to continue providing care.
“If the federal government pulled that grant, we’d be out of business, it would just be disastrous,” said the health center administrator who requested anonymity.
The grants allow some community health centers to receive higher Medicaid payments, free medical malpractice coverage and use revenue from prescription drugs to help pay for care. And as medical centers fear losing grants, more patients risk losing their health coverage due to cuts to Medicaid and other subsidized health plans.
Each year, more than a million patients across Massachusetts get their care from a community health center. Some of those centers have already voluntarily stopped services targeted by the Trump administration, apparently in line with the federal health care grant policy change that took effect on Oct. 1.
On that date, Fenway Health stopped offering gender-related medications to patients 18 and younger. If they hadn’t, a state commission reported, Fenway stood to lose $36 million in federal funding — cuts that would affect more than 30,000 patients. At least one additional health center, on Cape Cod, ended the same type of care a few weeks later.
Other health centers have quit distributing clean needles and related supplies to people who inject illegal drugs. Those strategies, known as harm reduction, aim to decrease infections and the spread of HIV and hepatitis. But federal health officials said in September these “efforts only facilitate illegal drug use and its attendant harm” and will no longer be funded.
Regina LaBelle, who worked in the Office of National Drug Control Policy under former presidents Barack Obama and Joe Biden, said she’s worried about the chilling effects of the Trump administration’s health care grant changes.
“At the same time we’re seeing overdose death rates go down, those programs that contributed to that decrease, they’re threatened,” said LaBelle, now a professor at the Georgetown University School of Health. “People are getting very nervous and perhaps not funding things they otherwise would to save lives.”
Grants have been cut with no notice. In January, federal health officials abruptly cancelled $2 billion in mental health and addiction treatment awards. Those funds were reinstated after a public outcry, but the experience left recipients anxious about what’s next. Last month, the Department of Health and Human Services pulled more than $600 million in public health grants from four Democratic-led states. A lawsuit challenging the termination is moving through the courts.
“People are getting very nervous and perhaps not funding things they otherwise would to save lives.”
Regina LaBelle, formerly of the Office of National Drug Control Policy
In its September statement of priorities, HHS said it intends to focus on “the chronic disease epidemic, the mental health crisis, obesity, nutrition deficiencies, exposure to chemical and environmental toxins and overreliance on medical interventions.” Some of the grants cancelled so far this year overlapped with those priorities, creating still more confusion for recipients. A spokeswoman for HHS did not respond to a request for clarification and other questions about the grant policy changes.
Many leaders of hospitals and health care centers that receive federal funding won’t answer direct questions from reporters about what services they provide or speak publicly about care that research shows works.
And the chilling effect appears to be spreading even to organizations that do not receive federal grants. One longtime street outreach worker in Massachusetts said she was fired in late January from a nonprofit where she spent most of her time helping people battling addiction. She trained community members to use Narcan, the overdose reversal medication, helped clients find medical care for wounds or injuries, and took them to addiction treatment. She also handed out syringes, all through a program labeled “harm reduction.”
“We’d been hearing for a while, ‘Don’t use that language,’ ” Jeanne said. WBUR agreed not to use her full name because she’s concerned that speaking out could impact her job search. “I’m worried about all the people — 40 or so — I’d see every day.”