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Federal and state funding cuts, freezes and delayed payments are hammering Richmond's free clinics, the region's health care safety net, officials from the groups told a community town hall at Health Brigade's clinic near Scott's Addition.
The cuts, some of which date back to last year, have been particularly deep for services for prevention and treatment of HIV, the virus than can cause AIDS. It also leaves people vulnerable to difficult-to-treat tuberculosis and other contagious disease.
The cuts, freeze and slow payments are pushing some decades-old Richmond institutions to the wall.
Health Brigade has seen a $1.84 million cut in federal and state funding, said Karen Legato, executive director of Health Brigade, founded as the Fan Free Clinic 55 years ago.
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"In June of last year, we were notified that all of our HIV prevention money had been cut. We had several testing grants, those were cut," she said Thursday of some federal cuts.
The grant for Health Brigade's clean syringe program, which also distributes naloxone kits, medication that reverses opioid overdoses, was also cut.
"It's only been a month when we had the conversation that they were cutting the entire CHARLI (the federal Comprehensive HIV/AIDS Resources and Linkages for Inmates) for the state," she said.
This program connects people coming out of prison who have HIV, and with treatment, medication, housing and other supports.
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"It's a highly successful program. It's one of the best programs ever seen in terms of outcomes," Legato said.
"And then the call the following week around Ryan White funding, which is for people living with HIV and AIDS, that's care funds, they cut another $250,000 from us," she said.
She was referring to the U.S. Department of Health and Human Services Department's Ryan White HIV/AIDS Program. It is supposed to provide a comprehensive system of HIV primary medical care, medications, and essential support service for low-income people with HIV.
The Ryan White money that remains pays for a few case managers, but Washington cut money for all the direct service pass-through dollars for food and housing and emergency assistance, she said.
"Some of the struggle we have had in the past year ... is when you're having grants from the state, is the safety net has to finance the state services until you get paid from the state."
Health Brigade handles several public health services, paying for the testing and treatment itself and then seeking reimbursement from the state.
"When we run out of cash because we're waiting for the state to pay, we have to go to a line of credit to float us until those payments come in," she said.
"And what that means for us is that our line of credit bottoms out. So we're at $500,000 on our line of credit right now. We can't get any more," she said.
"We had $300,000 we were owed by the state, and we almost couldn't make payroll two weeks ago," she said.
CrossOver Healthcare Ministry has also been hit hard, said Dr. Vivian Bruzzese, the clinic's director of HIV programs.
"In May, one week, we learned that our program was completely cut the next Friday," she said, detailing a federal cut.
The cut totaled $935,000, said Julie Bilodeau, CrossOver's chief executive officer.
Daily Planet says it is facing a $1.3 million cut in federal grants and state administered payments.
Just this week, Daily Planet got word that federal funding is frozen for its "Every Woman's Life" cancer screening program for uninsured and underinsured women, said Dr. Patricia Cook, chief medical officer.
"Also, the vaccines for adults, a program that provides vaccines for uninsured and underinsured adults, has also been frozen in terms of not being able to expand to new sites. So for instance, Daily Planet had a new site, and we were unable to expand those vaccines," she said.
And while the portion of Ryan White HIV/AIDS program funding that flows from Washington to states requires the state to pay for direct medical care and drugs, it says payment for other services is optional.
"The state can choose to continue to provide housing ... the state decided not to provide housing anymore," Cook said.
"That is one direct cut that Daily Planet took. Previously, we housed eight people through Ryan White funding, and we were told we needed to evict them immediately," she said.
"That was a big hit, and that is a state-level decision that's not coming from the feds," she said.
CrossOver,Health Brigade and Daily Planet are trying to put together a group effort to keep critical services in place, Bilodeau said.
But there are still big changes coming - even without the pending cuts to other federal grant programs and Medicaid, Legato said.
Health Brigade, for instance, was hoping for federal funds for badly needed work on its 73-year-old clinic building, including the roof and heating and air-conditioning system.
Some of the money was to come from the Department of Energy, but "We were in the middle of negotiating the contract when we had gotten a call that DOGE had actually been reviewing it, and that's the end of that," she said, referring to the Department of Government Efficiency, which Elon Musk previously led.
Sens. Tim Kaine and Mark Warner had secured promises for more of the work, and " that was slated to go through and then the CR happened, and all that money disappeared," she said, referring to the "continuing resolution" short-term funding bill to keep the federal government from shutting down.
"Our facilities are up for sale. We need to do this in order to survive," Legato said.
"We're fortunate that we're in a location that has grown in value over the years," she said of the clinic's main building just outside Scott's Addition.
"So our plan is to sell and hopefully rent back for a year, or until however long it takes, hopefully less than a year, to move to a different space," she said.
"The staff and the board of health brigade, who have taken so much stress continue to do excellent quality service for clients, even when they know their jobs may be in jeopardy," she said.
"To a person, if you ask them what's their biggest concern, they will tell you it's their clients. They don't say anything about themselves. It's about their clients and their patients. That's what it's about."
Dave Ress (804) 649-6948
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Dave Ress
State Politics / Growth and Development Reporter
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