A Massachusetts health care coordination program that serves people experiencing homelessness, poverty and addiction is losing significant funding by June 30, leaving tens thousands of the state’s most vulnerable residents at risk of losing crucial support.
Logan Reimbold-Thomas is a case manager with the Community Partners program at Boston Health Care for the Homeless, where he and other case managers are anticipating the loss of their positions as the program comes to a close at the end of this month.
He said that while Program leaders are working with the SEIU 1199 Healthcare Workers union to find alternative roles for employees, their clients will suffer without case managers to help them navigate the health care system.
“We are our patients’ first call when a crisis comes. It’s pretty scary to think that at the end of this month, that first call is going to have to become someone else,” Reimbold-Thomas said. “Right now, we’re all in a scramble to figure out who that might be.”
Reimbold-Thomas manages a caseload of 50 clients, coordinates with physicians, and helps people experiencing homelessness access preventative doctor’s appointments instead of ending up in the emergency room.
“It happens a lot, especially for unhoused folks who really struggle to keep appointments or plan sometimes far in advance,” Reimbold-Thomas told GBH’s Morning Edition, “because the struggle is just to stay alive for one more day.”
Leadership at Boston Health Care for the Homeless appealed to state leaders and “pursued strong advocacy” in order to save the program, but were ultimately unsuccessful, interim CEO Denise De Las Nueces said in an internal email obtained by GBH News.
“This is not a decision BHCHP made; it reflects a broader policy and budget shift at the federal, state, and [health plan organization] level,” De Las Nueces wrote. “State budget constraints reflect the challenges affecting the broader health care landscape.”
Reimbold-Thomas says he and other Boston Health Care for the Homeless case managers have been directed to trim their client lists to the highest-need people — from 1,200 down to 150 people who will be served by just three case managers instead of the couple dozen currently on staff.
He says breaking the news to clients has been heartbreaking.
“They’re used to abandonment, and they’re very used to folks moving on, because turnover is very, very high in this field,” he said. “But then I have to say afterwards that no one’s coming to replace me, because the funding is gone and the program is over.”
About 35,000 clients across the state are served through 20 MassHealth Community Partners behavioral health and long term services programs, where care teams work closely with clients to access doctors, therapists, housing programs and behavioral health resources, with a focus on complex cases and high-needs individuals.
All 20 programs are slated to lose funding as a result of federal funding cuts to Medicaid, resulting in a state budget crunch, MassHealth spokesperson Stacey Nee told GBH News in a statement.
“We are beginning to see the real-life impact of those [funding] cuts at the state level,” Nee wrote.
Nee says individual programs are determining how they’ll implement the cuts and couldn’t confirm how many programs will be shuttered at the end of the month.
Last year, President Donald Trump passed a law reducing federal Medicaid funding by roughly $1 trillion over a 10-year span. As a result, Massachusetts’ budget for the coming fiscal year includes a 50% reduction in care management programs, Nee said.
“MassHealth is doing everything we can to protect our members and the essential care they rely on for their health and wellbeing,” Nee wrote. “Our proposed changes to care management programs are a targeted approach to control costs, bring us in line with other states, and protect access to care as much as possible.”
MassHealth is working closely with Community Partner organizations and health plans “to ensure any transitions of supports are handled thoughtfully and responsibly,” MassHealth’s Nee said in a statement to GBH News.
“MassHealth will still require that its health plans provide care management to the most vulnerable members,” Nee wrote.
Reimbold-Thomas says it’s undeniable that the state is feeling pressure from federal funding cuts, but he argues the decision to close the programs won’t end up saving the state money.
“The frustrating thing for me and for my coworkers and other advocates in this space is that our program was designed to actually save MassHealth money — save Medicaid money — by redirecting folks away from emergency services use towards preventative care, and it’s been working,” he said.
It takes time to build trust with clients in the system, Reimbold-Thomas says, and he’s afraid many current clients will fall through the cracks — missing appointments, losing insurance coverage due to paperwork lapses, and finding themselves with no one to turn to in a crisis. For those experiencing homelessness, mental health issues or addiction, he worries clients could be criminalized when they have no one to call.
“The burden is going to be borne mostly by the hospitals, but also by the criminal justice system as more folks probably are incarcerated out of this,” he said. “It’s just really sad.”
