WellSpace Health braces for Medicaid cuts threatening women’s health services in Sacramento

On July 4, the ”big, beautiful bill” reached the presidential desk and the largest cut to Medicaid since its inception in 1963 was signed into law. Analysts warn of a ripple effect across the health care ecosystem, leaving millions without health insurance and impacting safety-net hospitals. Meanwhile, back-door defunding through new anti-DEI policies have left health care nonprofits and long-established government programs — especially those supporting women’s and reproductive health — in the lurch.

In California, Medicaid cuts threaten the state’s Medi-Cal program, the implementation of the federal program that insures around 15 million Californians.Though the bill has been signed into law, the implementation of the cuts will take place over a 10-year timeline beginning in 2027 — after the 2026 midterm elections.

At WellSpace Health and in community health center waiting rooms that provide care to underserved populations across the Sacramento region, the questions have begun: How will a major scale back of federal funding affect the care patients have come to depend on?

“The general uncertainty, the general fear has started to present itself in our patients,” said Christie Gonzales, chief operations officer of WellSpace Health.

Wellspace Health has weathered many shifts in the political and health care landscapes since it’s founding as a nonprofit community health center in 1953 — first as a free clinic with their still-running 988 suicide hotline, and eventually expanding to provide comprehensive medical, dental and behavioral health. In 2009, WellSpace became a Federally Qualified Health Center (FQHC) — a status designated to primary care clinics that receive federal funds to provide services in high-need communities — and now serves approximately 125,000 individuals a year, or about 1,400 people a day for any number of services covered through Medicaid and Medi-Cal, according to Gonzales.

One way the administration plans to achieve their record setting Medicaid cut is by instating work requirements. Beneficiaries will be required to prove they are employed or in school at least 80 hours a month to maintain coverage, which would render about six million people uninsured. FQHCs like WellSpace Health typically cover the cost of these visits for uninsured folks, stretching the federal reimbursement funding they receive to serve everyone. Currently about 10% of WellSpace’s patients are uninsured, a number that is sure to increase over the next 10 years.

“If [one of our patients] loses their Medi-Cal due to work requirements, due to documentation status, whatever it may be, they’re still going to look to WellSpace Health as their provider,” Gonzales said.

Dr. Janine Bera, chief health officer of Wellspace Health, fears that the increased fiscal strain on Medicaid providers will result in a system collapse.

“There is no one else to provide this [primary care] across the country, maybe there’s a handful of private docs, but not really. I can’t think of anyone in the Sacramento region.” Bera said, noting that people will turn to emergency rooms for care, or wait to get treatment all together. “We as doctors can’t turn them away. That’s against the law, and it’s against our hearts as good providers. … But to what detriment? If we’re not turning people away, does that mean we incur all these great costs? Then we end up with the whole system collapsing because we have to close our doors because we were taking care of so many people who don’t have reimbursable visits that we can’t maintain our staff.”

Impact on women’s health care

Of WellSpace’s quarter-million patients, 60% identify as women or female. They rely on WellSpace for comprehensive women’s health care, from their Perinatal Service Program — offering monthly one-on-one classes on general baby care, sleeping, breastfeeding and what to expect in that first year — to support programs for women experiencing drug and alcohol addiction during pregnancy.

They also offer a gamut of gynecological services beyond natal care like tests and screenings for all sexually transmitted infections, menopause support and surgeries for hysterectomies and uterine cysts.

As one of the Birth and Beyond Family Resource Centers in Sacramento, WellSpace not only supports women’s health during pregnancy, but also makes sure new babies get the pediatric care they need. “They find us for prenatal care, but we show how we can be a part of their family’s health into the future,” Gonzales says.

WellSpace Health delivers one out of every 10 babies born insured through Medicaid in Sacramento County, and has been instrumental in reversing infant mortality trends, particularly in Black babies, who used to have a 50% higher mortality rate than babies of other races. Through their Assuring Neonatal Kinship and Health Program that focuses on improving the health of Black women and Black infants in Sacramento County, WellSpace Health has helped reverse the trend of higher rates of prematurity and low birth weight– factors that drive infant mortality.

“Women’s health is pretty much all encompassing. That is primary care.” Bera said, with the added impact of care for moms and their children. If mothers wait until their third trimester to seek care, that becomes a high-risk pregnancy with an increased risk of complications for the mother and the baby.

And waiting for care can be costly and dangerous. Skipped mammogram screenings could turn an early-stage cancerous lump in a woman’s breast, solved by a simple surgery if caught early, into metastatic cancer, which requires a much larger, physically taxing care plan with higher risks, and more costs to the system as a whole.

“If they’re not getting [care] in a primary care setting, like at a WellSpace Health, where are they going to end up? We’re going to see them in the emergency departments. We are going to see them in these other safety net services. They’re not going to go away,” Gonzales said.

For women’s health care, this means uninsured patients will turn to nonprofit providers who offer low and no-cost women’s health care, “safety net” service providers. But these are far and few between. In Sacramento, for instance, Planned Parenthood is the only option for uninsured patients to receive comprehensive care including abortion.

Sylvia Castillo, executive director of the California Coalition for Reproductive Freedom (CCRF), which includes 40 member organizations and manages the California Future of Abortion Council — established in partnership with state legislators to protect abortion access before the Dobbs decision, says that compared to the first Trump presidency, these cuts and crackdowns are “10 times worse,” in part because there is less fiscal flexibility for the state to pushback.

“We don’t have the budget this time around to try to backfill, to try to keep some of these [services] open and available, and that’s the scary part,” Castillo said.

In this year’s state budget, the CCRF was fighting to renew a historic $2 million reproductive health package that created the Uncompensated Care Grant Program and the Practical Support Grant Program, among others, to ensure contraceptive and abortion access across the state. The funding did not make this year’s budget, and the active grants will continue with no promise of renewed funding.

“They’re not just attacking abortion, they’re attacking the providers themselves. If those clinics shut down, it’s not just a loss of access to abortion, but the range of reproductive health care services. And although we do have a robust system of community health centers, they are certainly nowhere near equipped to take on all of those patients that would have to migrate over,” Castillo says. “In attacking abortion, they end up attacking the entire spectrum of reproductive sexual and reproductive health services. It doesn’t just impact women, it impacts everyone.”

The future of funding

With looming changes to both eligibility and funding for Medicaid programs, questions remain about where to turn to cover the funding gap.

Ben Avery, chief public affairs officer for WellSpace Health, worries that alternative funding streams were absorbed when the Affordable Care Act was created.

“Prior to the Affordable Care Act, there was actually a diverse array of funding strategies that covered [Medicaid]; it was hodgepodge. You had [the California Healthy Families Program], you had county medical services, you had decades of funding structures that had built up for individual populations. … Plus on top of that, you had Federally Qualified Health Centers that were able to kind of make it all work,” Avey said. “When you cut Medi-Cal, all of those other funding streams no longer exist.”

With Medicaid federal funding pulled, community health centers are limited in alternative sources of funding to cover the gap.

Gonzales said they are being “planful,” training employees on what work requirements might look like and how to help patients with more frequent verification paperwork. Big picture, Gonzales said they’re thinking about the extended medical ecosystem in Sacramento: “How do we maintain our ecosystem, and how do we lean on the larger Sacramento community, medical provider ecosystem to [work through this] together? It’s a conversation for the community and for all providers.”

Most importantly, the WellSpace Health team is turning their attention to reassuring their patients. “We’re here, that hasn’t gone into effect yet,” Gonzales said. “Once we know, we can adjust.”