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A health provider that offers sexual and reproductive services to thousands on the South Coast is at risk due to funding cuts enacted through President Donald Trump’s budget law, better known as the “One Big Beautiful Bill.”
Health Imperatives on Friday was notified by MassHealth, the state’s Medicaid provider, that effective immediately, the health clinic may no longer bill Medicaid for services. The organization, which serves more than 20,000 people in Southeastern Massachusetts annually — mostly women — estimates it will lose nearly $1.8 million a year in reimbursements. That amounts to about 20% of its clinic revenue.
The notice comes weeks after federal officials in court filings identified Health Imperatives as one of just two health organizations in the nation beyond Planned Parenthood that may be prohibited from receiving federal funding under a niche provision regarding abortion services.
“This isn’t about abortion. Medicaid has never paid for abortion,” Julia Kehoe, CEO of Health Imperatives, said in an interview with The Light. “What this is is punishing organizations that provide abortion and saying all the cancer screenings, all the HIV prevention, all the annual exams, you can’t get reimbursed for. This is just one more assault on the programs and people we serve.”
The budget bill, signed into law on July 4, directs that for one year, no Medicaid funds may be used to pay a “prohibited entity.” The law defines a “prohibited entity” as one that is “primarily engaged in family planning services, reproductive health, and related medical care”; provides abortions; and received more than $800,000 in funds through Medicaid in 2023.
Kehoe did not provide a figure for Medicaid funding in fiscal year 2023, stating questions remain as to whether they hit the threshold, as some of their billings only went to MassHealth and not to Medicaid.
Kehoe, however, said sexual and reproductive services account for about 40% of the work they do, and that the organization shouldn’t fall under the provision’s definition of a “prohibited entity” because a majority of its work is in other forms of health care.
Health Imperatives routinely provides medication abortion; breast and cervical cancer screenings; sexually transmitted infection testing and treatment; contraception; crisis counseling for victims of domestic violence and sexual assault; housing through an emergency shelter; gender-affirming care with hormone therapy; and medication treatment for substance use disorder.
The nonprofit also offers the Women, Infants, and Children program, better known as WIC, a federal and state-funded program that provides food, nutrition education, and breastfeeding support to women who are pregnant or have children under 5 years old. Health Imperatives contracts with the Massachusetts Department of Public Health to administer the program.
Per Kehoe and Health Imperatives staff, its clinics last year provided approximately 32,000 STI tests, 6,600 HIV tests, contraceptives counseling for nearly 8,000 patients, 839 medication abortions, and about 4,200 cancer screenings.
Health Imperatives has locations in New Bedford, Hyannis, Wareham, Plymouth, Brockton, Nantucket, and Martha’s Vineyard. The clinics primarily serve low-income and at-risk women, adolescents and families, most of whom are on MassHealth or do not have insurance.
The nonprofit started providing medication abortion about two years ago, filling a gap in Southeastern Massachusetts, a region that has been termed an abortion desert.
Federal lawsuits
Health Imperatives now finds itself in the crosshairs of the federal government, becoming the subject of discussion in two lawsuits against the U.S. Department of Health and Human Services (HHS) in which Planned Parenthood has taken center stage.
In one of these suits, brought by the Planned Parenthood Federation of America, a federal judge in Boston last week granted a preliminary injunction in favor of the organization and its member clinics, ruling that they may continue to collect reimbursements from Medicaid.
U.S. District Judge Indira Talwani determined that the budget law’s provision that cuts Medicaid funding targeted Planned Parenthood — in part for providing abortion and advocating for reproductive rights — and as such may be unconstitutional.
“Plaintiffs are likely to establish that Congress singled them out with punitive intent,” she wrote in her July 28 order.
But the preliminary injunction only applies to the plaintiffs, so Health Imperatives is not covered by it, Kehoe confirmed.
Last month, the U.S. Department of Justice named only two other organizations — Health Imperatives and a Maine clinic — to defend the bill’s provision and argue that the federal government is not targeting Planned Parenthood.
The definition of prohibited entity “may apply to other entities, including Health Imperatives and Maine Family Planning,” wrote federal attorneys on July 14. “That proves that” the provision “is a law of general applicability, not a targeted punishment for a singled-out entity.”
In a supplemental affidavit, dated July 14, Drew Snyder, the federal government’s assistant director of the Centers for Medicare and Medicaid Services, wrote that his staff had “analyzed data” to identify at least two “non-Planned Parenthood entities” that fell under the provision’s definition of prohibited entity.
Naming Health Imperatives and the Maine center, Snyder wrote that both received more than $800,000 in Medicaid funding in 2023 and have provided “abortions other than those identified in the Hyde Amendment.”
The amendment, which dates to the 1970s, bars the use of federal funds to pay for abortion, except in extreme cases such as rape, incest, or threat to the life of the mother. (In Massachusetts, MassHealth, through state funds, covers abortion services.)
Advocates view this amendment as a bar to reproductive health care, especially for low-income women and people of color.
The day after Judge Talwani issued the injunction, Massachusetts, with 20 states and the District of Columbia, sued HHS over what they call this “defund provision” that strips Medicaid funding from reproductive health centers that regularly provide care outside of abortion.
“The Defund Provision effectively strips that care from Medicaid enrollees, many of whom will likely go without care,” the states wrote. “The result will be, among other things, delayed diagnoses of cancer and STIs and increased unintended pregnancies, which will result not only in widespread and devastating effects on the health of vulnerable residents of the Plaintiff States, but also in increased costs to the Plaintiff States’ Medicaid programs.”
The states’ complaint names Health Imperatives, stating MassHealth “initially” did not consider it as a prohibited entity, but that HHS has “assumed the opposite position.”
The states criticized the federal government over a lack of guidance for state agencies to determine if an entity is prohibited, and without such guidance, MassHealth “may be at risk of applying the law differently” than the federal government.
Last week, MassHealth made a determination.
“We just had a call with [MassHealth] on Friday. They determined after reviewing the latest information with their attorneys that it was too risky for them and us to bill [Medicaid],” Kehoe said, “even though they don’t necessarily believe we should be impacted by this.”
The Light contacted HHS and the Centers for Medicare and Medicaid Services for comment Tuesday morning and did not hear back before publication.
MassHealth did not comment by the close of business Tuesday.
Kehoe said the organization would continue to work with the state and try to raise more funds from foundations and individuals.
“It’s really important to acknowledge how demeaning and demoralizing it is for people who are trans individuals or immigrants or anyone in need who is being a target of some of these hateful policies,” Kehoe said.
She added people should not be deterred by federal policy, and should continue coming to the clinics for necessary health care.
Email Anastasia E. Lennon at alennon@newbedfordlight.org.
Everyone can receive healthcare, all that’s required is working for a living and, and paying for healthcare premiums with your employer as most responsible people do. State and federal tax payers shouldn’t be required to pay for anyone’s healthcare beyond themselves and their families.
That’s what changed, nothing more, nothing less.