Kelly Kenley’s community clinic in rural Minnesota has already survived one crisis this year: her Open Door Health Center didn’t get federal funds for 10 days after Russell Vought—the Project 2025 architect turned head of the Office of Management and Budget—orchestrated a funding freeze in January that plunged Medicaid and other funds into chaos.
“We could still make payroll,” Kenley said, but added that some other health centers in Minnesota couldn’t—and may have had to resort to staff furloughs, or worse.
The country’s first community health centers, or CHCs—neighborhood clinics that do not turn away uninsured patients, and charge sliding-scale fees—were formally piloted in the 1960s under the auspices of President Lyndon B. Johnson’s War on Poverty; in 1977, Congress started to fund them federally, and successive administrations pushed to expand the program. There are now more than a thousand community health centers across the US, providing some 32 million people annually—about a third of whom are children—with a wide range of services including primary, dental, and behavioral care. About six in ten CHC patients are people of color.
“When I say we will run out of money, that’s counted in weeks and months.”
“Roughly 90 percent of our patients have incomes below 200 percent of poverty, and about 50 percent are enrolled in Medicaid,” said Minnesota Association of Community Health Centers CEO Jonathan Watson. “We’re part of the healthcare safety net [and] our role is really to keep communities healthy where they’re located.”
Medicaid payments make up around 40 percent of CHC operating budgets, although that figure varies by state, according to KFF. If Congress slashes Medicaid funding to the tune of hundreds of billions of dollars, as House Republicans have proposed in a Trump-endorsed plan, the future of many health centers will be in peril. Perhaps ironically, seven House Republicans who voted for the plan also sit on the Congressional Community Health Centers Caucus, including two of its co-chairs, Rep. Troy Balderson (R-Ohio) and Rep. Jen Kiggans (R-Va.). “When I say we will run out of money,” Kenley said, “that’s counted in weeks and months, that’s not counted in years.”
Many CHCs do not operate with a lot of money leftover, according to the Commonwealth Fund: in 2019, their total revenue was $31.43 billion against operating costs of $31.16 billion; in 2021, that margin was $38.85 billion to $36.79 billion; in 2023, it was $46.75 billion against $46.01 billion. The centers, the Commonwealth Fund wrote, “grappl[e] with uncertainty over the timing and generosity of future federal investments.”
Medicaid coverage was vastly expanded by the Obama-era Affordable Care Act; many GOP-run states now face the prospect of rollbacks that would strip millions more Americans of health insurance, driving up the need for community care while taking away a key source of its funding. Private practices, Watson said, have no obligation to offer sliding-scale rates—and can’t bridge the gap.
Kenley is not opposed to Medicaid reform—but the closure of CHCs, she said, will drive an influx of Medicaid patients to emergency rooms instead, which costs Medicaid more. A 2020 study focused on Massachusetts also linked community health center visits to decreased non-emergency ER visits. In addition, a 2009 study found that in Georgia counties with no community health centers, uninsured people were more likely to go to the ER.
In other words, Medicaid-backed clinics are cost-efficient—and indispensable to the communities they serve. “Day to day, we’re seeing a lot of patients where they walk through our doors and it’s probably the first time they’ve received any medical or dental care in years,” Kenley said.
“Particularly heartbreaking,” she said, was “the number of children that we see in our dental department that have never had routine dental care, who are in pain.”
