As Medicaid Shrinks, Clinics for the Poor Are Trying to Survive

Appointment cancellations and financial distress have become a constant at Bethesda Pediatrics, a nonprofit medical clinic in East Texas that is heavily dependent on Medicaid, the health insurance program for the poor.

On a recent Monday, the mother of a toddler who had a primary care appointment broke down in tears after learning the child had just lost Medicaid coverage, wondering how she could pay the bill.

Another mother told Dr. Danny Price, the clinic’s lead pediatrician, that she was afraid to get her child a flu shot because of the $8 fee she would have to pay now that the child had been dropped from Medicaid.

A child with depression did not show up, most likely, Dr. Price presumed, because of having lost Medicaid coverage.

The uncertainty and panic at the clinic, tucked inconspicuously in a poor residential pocket of Tyler, Texas, highlight a little-examined consequence of the vast trimming of the Medicaid rolls since a policy that barred states from kicking anyone out of the program during the pandemic ended last spring. The loss of coverage has not only affected families, but is also threatening the financial stability of vital components of the American safety net.

Medicaid payments are “the lifeblood of our health centers and their ability to serve,” said Dr. Kyu Rhee, the president and chief executive of the National Association of Community Health Centers, which treat roughly one in 11 people in the United States and rely on Medicaid and federal grants to provide a financial cushion for the uncompensated care they give uninsured patients.


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