Longer wait times and less money to pay nurses and doctors. 

That’s what Domonic Hopson, the CEO of Neighborhood Family Practice, predicts would occur at his community health care center if federal changes to Medicaid cause Ohio to slash coverage for adults with low incomes. 

Hopson said the nonprofit could lose as much as $2 million a year without what’s referred to as Medicaid expansion. 

“When we look at a revenue hit of that size, I don’t think there’s any program or service that we offer that won’t be impacted in some way,” Hopson said. 

“We know for sure, though, we won’t continue to be able to serve as many patients or the range of services that we’re offering.”

The hit to Neighborhood Family Practice’s budget represents a fraction of what the Greater Cleveland area risks if Medicaid expansion were to end: a $596 million drop in health care spending among people under 65, according to a recent report from the Urban Institute. 

That’s a 4% drop in spending, which includes money that would otherwise go to hospitals, dentists, prescription drugs and federally qualified health care centers like Neighborhood Family Practice. The center provides primary care, behavioral health care, maternal health care and dental care at seven clinics near the West Side of town. It’s also the primary healthcare provider for several refugee resettlement agencies.

The Urban Institute’s report comes as Medicaid expansion is under threat. Ohio expanded the federal program in 2014, and it now covers nearly 100,000 residents in Cuyahoga County. But in February, Ohio Gov. Mike DeWine proposed the budget bill that would end Medicaid expansion if federal match funding for the program shrinks, a possibility congressional Republicans in D.C. are considering. Previously, state officials have said the provision is needed to “protect the state’s general fund in the face of uncertainty at the federal level.”

The rate of uninsured Ohioans has shrunk by half since 2014. If the state reverts to the higher uninsured rate, medical providers and the people they treat would be seriously impacted, said Emily Campbell, president and CEO of the Center for Community Solutions. The nonpartisan think tank advocates in favor of Medicaid. 

Campbell said much of the region’s employment in the health care sector is underpinned by Medicaid – so reductions could mean losing medical staff. 

“There’s already challenges for people who are struggling with mental health issues or addiction issues to find providers that take their insurance,” Campbell said. “We’re really worried that there may be fewer providers overall if some of these things happen.”

How the money flows: Neighborhood Family Practice

Medicaid funds health institutions such as hospitals and clinics by reimbursing them for care provided. For example, when a resident sees a physician, the health center bills Medicaid for that visit, receiving dollars in return. 

That money covers a large chunk of the cost of running a non-profit health clinic like Neighborhood Family Practice: salaries, utilities, supplies. Over half of the health care center’s 22,000 patients use Medicaid.

But that income would shrink for Neighborhood Family Practice if Medicaid expansion disappears and more residents are uninsured, Hopson said. As a federally qualified health care center, Neighborhood Family Practice would continue to serve all uninsured patients – but without Medicaid, it would have to pick up the entire tab of caring for patients who lost coverage. 

In total, Hopson predicts losing 3.5% to 6% of the health center’s revenue if Medicaid expansion disappears – a hit that will decrease services while demand is at an “all-time high,” he said. 

“We may not be able to afford to have as many providers, so it’s going to take longer for patients to get in to be seen,” Hopson said.  

Hopson said he worries the cuts could pull focus away from the community’s dedication to addressing existing health disparities. Black women in Cuyahoga County have higher rates of infant and maternal mortality than other women in the county. Neighborhood Family Practice has a partnership with Birthing Beautiful Communities, a local doula program dedicated to supporting Black mothers and infants.

“I’m afraid we’re going to lose some of that momentum if this happens,” Hopson said of the center’s work on addressing health disparities.

Hopson said the nonprofit is considering seeking out more private donations if Medicaid expansion disappears. But it would need a significant increase: Currently, just about 4% of the center’s revenue comes from philanthropy. 

Hospitals face major losses in face of Medicaid cuts

The Urban Institute report finds hospitals would face the largest revenue losses if Medicaid expansion were to disappear. 

In the Cleveland area, hospital spending for those under 65 would dip by $239 million if Medicaid expansion is cut, the report finds. 

The loss of these dollars could reduce the quality of care hospitals provide, said Fred Blavin, the report’s author and senior fellow at the Urban Institute. That might lead to cutting back on services often used by Medicaid recipients or on services that are less profitable.

“A lot of times you see some hospitals cutting back on their maternity care wards,” Blavin said. “Something along those lines. Or potentially cutting back on drug and rehabilitation services.”

Hospitals that serve larger populations of patients on Medicaid are likely to feel more consequences, Blavin added.

MetroHealth, a publicly funded health system, serves the highest percentage of Medicaid patients of the city’s three primary hospital systems. Thirty-one percent of its patients used Medicaid in 2023, compared to 18% at University Hospitals and 13% at Cleveland Clinic. 

The city’s three largest hospital systems said in statements that cuts to Medicaid would negatively impact their operations and patients. MetroHealth and University Hospitals said they  are talking to elected officials about the importance of Medicaid. 

“We are regularly meeting with elected officials to highlight the benefits federal health insurance programs, including Medicaid and Medicare, provide to the community we serve and the negative effects steep cuts could have to our patients,” wrote a MetroHealth spokesperson in an email to Signal Cleveland.

Hospitals in stronger financial positions are more likely to weather Medicaid cuts without reducing quality of care, Blavin said. Of Northeast Ohio hospitals, only the Cleveland Clinic posted a budget surplus instead of a loss in 2024, cleveland.com reported. 

The Urban Institute report also found that, without Medicaid expansion, hospitals would have to provide more charity care – medical treatment for which they don’t get paid. When this occurs, hospitals are more likely to raise prices for everyone unless another government entity steps in to fill the gap, said Campbell, the president and CEO of the local think tank.

“What we see are the costs for people with health insurance going up,” Campbell said. “Because it’s all baked into the calculations of how much a health system needs to charge in order to be able to meet their expenses, just like any business.”