Federally qualified health centers across Connecticut are facing uncertainty about whether they can continue serving undocumented residents — a key patient base — following a recent move by the Donald J. Trump administration to reverse a decades-old policy that gave people without permanent legal status access to certain federal benefits, including care at community health centers, behavioral health programs and Head Start.
The U.S. Department of Health and Human Services last week announced it would bar undocumented residents from accessing taxpayer-funded federal programs. Among the more than a dozen initiatives affected is the Health Center Program, which provides funding to community-based health providers.
Connecticut has 17 federally qualified health centers with more than 300 facilities. The centers serve about 440,000 people annually statewide, including more than 70,000 who are uninsured.
Of those, officials estimate that anywhere from 20,000 to 60,000 patients per year are undocumented residents, who are charged for services based on a sliding fee scale. The health centers don’t have a more precise number because employees do not inquire about patients’ immigration statuses, said Deb Polun, chief strategy officer for the Community Health Center Association of Connecticut.
For now, the FQHCs are continuing to serve everyone who shows up for care while they await further information from HHS, Polun said.
“There is a lot of fear and confusion,” she said. “It’s a fundamental shift in how health centers do business. Our mission is to try to serve all residents, to help create healthier communities, to help people get and stay healthy so they can live high quality lives and contribute to their local economies. This changes the way they will have to do business. It will lead to people being sicker.”
Without access to primary care at community health centers, Polun said, more people will put off treatment and end up in hospital emergency departments when medical care is badly needed.
“We’ve already had patients fearful of becoming detained or deported, so we’ve seen a change in some of the behaviors — more cancelations, more, ‘Can we switch this to telehealth instead of coming in?’ This is one more obstacle, one more barrier to them being able to access health care,” she said.
Leaders at community health centers say the move is complicated by federal regulations that also require them to provide care to all residents in their service areas.
“Community Health Centers are required by federal law to ensure access to health care for all residents in their service areas. This is core to their mission to build healthier communities,” Sean K. Frick, CEO of the Community Health Center Association of Connecticut, said in a statement. “[The] notice from the U.S. Department of Health and Human Services raises significant questions about how community health centers in Connecticut and across the country can continue to meet their legal and moral obligations.”
The move could mean having to ask for and verify patients’ immigration statuses at facilities and turn away people who receive coverage through the state’s HUSKY for immigrants program, which offers government-sponsored health benefits to certain undocumented residents, officials said. As of April, 15,600 kids in Connecticut were enrolled in the program.
Aside from undocumented immigrants, access to care could also be rolled back for children covered by the Deferred Action for Childhood Arrivals (DACA) policy, refugees and individuals granted asylum under the new rule, health officials said.
Attorney General William Tong said his office is “evaluating all legal options” in response to the recent notice.
“When you deny huge swaths of people access to affordable community-based health care, their medical needs do not go away,” Tong said in a statement. “They get sicker, their problems become more severe, more life threatening and more expensive to treat. And then they show up in emergency rooms — often too late. No one thinks this is a good idea — not the health centers, not the hospitals, and least of all not the Connecticut families who will be hurt by this needless cruelty.”
Sen. Saud Anwar, D-South Windsor, co-chair of the legislature’s Public Health Committee and a physician, called the move “short sighted.”
“We know the cost of health care goes up for everyone if preventive treatments are not provided. People residing in our communities, if they receive preventive treatment, they are less likely to have emergencies,” he said. “If treatment is not received because of fear or other decisions, the actual cost of health care for everyone will increase, and this is not a good financial decision.”
Christine Stuart, a spokeswoman for Connecticut’s Department of Social Services, said the office is still assessing the impact of the federal decision on programs and on the state’s partner organizations.
This story was originally published by the Connecticut Mirror.