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Primary‑care centers and nonprofits warn HR 1 may force service cuts and threaten safety‑net capacity
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Summary
Federally qualified health centers and statewide nonprofits told lawmakers that HR 1’s changes to Medicaid and federal funding, along with tax changes affecting corporate giving, could shrink revenue to clinics and community agencies and raise uninsured rates. FQHCs estimated a potential ~11% revenue hit (mid scenario) and asked the legislature to consider property‑tax relief, expanded 340B protections and other supports.
Leaders of Nevada’s federally qualified health centers (FQHCs) and statewide nonprofit intermediaries told the committee HR 1 threatens core safety‑net capacity.
Nancy Bowen (CEO, Nevada Primary Care Association) outlined who FQHCs serve: low‑income, often non‑English‑speaking patients, many with unstable, gig‑economy income that is frequently under‑captured by automated wage records. Bowen said Nevada FQHCs served roughly 128,000 unique patients and provided about 428,000 visits in 2024; about 69% of those patients are uninsured or on Medicaid.
Steve Messenger (Policy Director) presented modeled impacts: if around 25,000 expansion patients served by health centers become subject to work requirements, mid‑range estimates (54% compliance midpoint) imply about $17M/year in lost revenue across the FQHC network (≈11% of operating revenue), potentially eliminating an estimated 107 FTEs and forcing cuts to care navigation, behavioral health and other wrap‑around services.
United Way of Southern Nevada and the Guinn Center presented complementary analysis: the Guinn Center found that in a FY2025 snapshot roughly 17.5% of certain federal pass‑through dollars went directly to nonprofits (and within DHHS pass‑throughs, ~40% went to nonprofits). United Way described logged increases in requests for basic needs and reports from nonprofits of shifts in philanthropy and funder priorities that complicate operating budgets. United Way also noted the EFSP (Emergency Food and Shelter Program) pause: the local board had not released EFSP funding since January 2025, constraining one safety‑net source.
FQHC leaders and nonprofit representatives urged several state responses: expand navigator funding to enable enrollment and presumptive eligibility at point‑of‑service; protect and enhance 340B/discounted drug program access and clinic billing parity so health centers do not face discriminatory payer practices; consider targeted property‑tax or other relief to reduce operating costs; and invest in data infrastructure to trace federal pass‑through dollars to final recipients.
Why it matters: FQHCs and community nonprofits are front‑line access points for primary, behavioral and preventive care. Revenues tied to Medicaid and federal grants underpin services, and losses could force reductions in services that prevent higher downstream costs in hospitals and emergency care.
Next steps: The associations requested the committee champion FQHC investments, consider property‑tax or other operating relief, and commission further data work on federal pass‑through exposure and philanthropic trends.
