Prince George's County health department outlines options to restructure uninsured care program amid budget uncertainty

Councilwoman Walla Begay, chair of the Prince George's County Council health work group, heard a briefing from county health officials and community clinic representatives about uncertainty in funding and a possible restructuring of the county—s uninsured-care program during a work group meeting.

The Prince George's County Health Department—s chief of health policy and innovation, Stephanie Soleil Whittle, said federal and state budget actions are creating "downstream impact" on local programs and that the department is considering changes to how Prince George's Cares and the county—s Health Assures reimbursements are structured. "Today, we want to just do a brief review of the potential federal and state cuts and what that looks like as it impacts to the health department," Whittle said.

Why it matters: Officials said potential federal cuts to Medicaid and other programs and a state budget deficit are likely to increase the county—s uninsured population and increase demand for wraparound services. That, they said, would put strain on existing funding and on the county—s ability to pay clinics that serve uninsured residents.

What officials told the work group

- Federal and state risk factors: Whittle listed several federal programs that could face reductions or program changes, including proposed reductions in Medicaid spending, pauses in some federal vaccination studies, and possible reductions to Ryan White and SAMHSA funding. She told the group the state is working to close an approximately $2.7 billion deficit.

- Current and pending county funds: For fiscal year 2025 the program had $4.2 million budgeted; Whittle said the health department had received $1.5 million and still needed the remaining $2.7 million to be appropriated before it could pay outstanding invoices. For fiscal year 2026 the acting county executive proposed $1 million for the program, pending the county budget process.

- Two model options under consideration: The health department described two broad approaches. A program-centered (reimbursement) model would continue paying clinics on an invoice basis and require less county administrative infrastructure. A patient-centered model would let funds "follow the resident," place caps on per-patient allocations, and require standardized data collection, claims processing and program oversight.

- Staffing and infrastructure needs: Whittle and Dr. Diane Young, associate director of family health services, said the health department currently lacks dedicated staff to run a standardized program and identified baseline positions they believe are needed: a program manager, a compliance analyst, an eligibility specialist and a data analyst. Young said these positions are not currently in the department—s budget and that, if the department wanted an "ideal state," it could need roughly double that staffing.

Clinic and community concerns

- Clinics and advocates urged careful attention to rates and the operational impact of any model changes. Suyanda Leanes Barker of La Clinica del Pueblo said that FQHCs negotiate Medicaid rates that reflect wraparound services and warned that comparing simple per-visit numbers to Medicaid does not capture the full cost of care. "We negotiate our rate with Medicaid and we get paid by a negotiated rate," she said.

- Dr. Bruton of CCI cautioned against setting rates too low to achieve a guaranteed program. He said the group previously opted to risk running out of money rather than setting a low guaranteed rate that would not cover clinic costs, and gave his center—s Medicaid-derived cost per primary-care visit as $320.13. "We purposely... decided we would prefer to run out of money and have a rate that was more close to our actual cost than to have a low rate that was guaranteed," he told the work group.

- Community and clinic representatives said program design must account for the complexity of patients served by FQHCs, including undocumented and immigrant populations and medically underserved neighborhoods, and the value of wraparound services that clinics provide beyond a simple office visit.

Comparisons and next steps

- The health department said it has been reviewing regional models such as Montgomery Cares and programs in Washington, D.C., Fairfax County and the Kaiser "Care for Kids" model that follows patients. Montgomery Cares currently pays about $102 per primary-care visit (proposed to rise to $112), while the county—s current per-visit average payments are higher; the health department said it is examining how to balance reimbursement levels against program longevity.

- Timeline and deliverables: Whittle said the department hopes to complete a fuller analysis within roughly a month, but she did not promise the study would be ready for the work group—s next scheduled meeting. The department will appear before the work group on April 28 at 11:00 to provide further detail, and staff agreed to share the presentation slides with attendees. Whittle said outstanding FY25 invoices cannot be paid until the supplemental appropriation is processed and funds are uploaded into the county system.

Votes at a glance

- A procedural motion to approve the minutes from the last three work-group meetings was made, seconded and approved by voice vote.

Ending

Work-group members and health department staff agreed to continue the analysis in coordination with clinics and advocates, with the health department focusing on whether to keep a reimbursement model or develop a patient-centered program and on what staffing and data systems would be required. Councilwoman Begay emphasized using the work group as a venue for those policy decisions, and members asked the department to return with a more detailed assessment in the coming weeks.