Kaine, Warner Lead Colleagues in Raising Concerns about Virginia Community Health Centers’ Delays in Accessing Funding

WASHINGTON, D.C. – Today, U.S. Senators Tim Kaine and Mark R. Warner (D-VA) led 20 of their colleagues in writing a letter to U.S. Department of Health and Human Services Acting Secretary Dorothy A. Fink, M.D. regarding reports that Health Resources and Services Administration (HRSA) grantees, including community health centers, are experiencing significant delays in accessing funding. The senators also expressed concerns about restrictions on regular communications between HRSA and grantees. These issues come after an Office of Management and Budget (OMB) memo that suspended all federal grant and loan funding. The memo has since been rescinded following pressure from the senators, other Democrats in Congress, and the public, but many grantees that rely on federal funding are still experiencing confusion and uncertainty, and have received little to no guidance from the Trump Administration about their funding.

There are 31 Federally Qualified Health Centers with over 200 locations—a majority of which serve rural areas with limited access to medical care—in Virginia. Due to the funding freeze, several centers within the Capital Area Health Network closed earlier this week. Kaine and Warner met with Virginia community health centers earlier this week.

“We are writing to express serious concerns regarding reports that Health Resources and Services Administration (HRSA) grantees, such as Community Health Centers (health centers), continue to experience significant delays in accessing funding to support services, as well as restrictions on regular communications with agency staff as a result of the Trump Administration’s January 20, 2025 executive orders to pause external communication from federal agencies, and subsequent memorandum directing all federal departments and agencies to freeze all financial assistance.” wrote the members.

The members continued, “While nearly 70 percent of health center revenue comes from payments from Medicaid, Medicare, commercial insurance, and self-pay patients, health centers rely on their regular federal grant funding to meet payroll obligations and keep their doors open. Beginning in late January, health centers started reporting issues accessing the Payment Management System (PMS) – getting “locked out”, being denied funding they had been awarded, and experiencing long delays in funding being released. As a result, health centers across the country are experiencing panic, unsure how to pay their staff and keep their doors open.”

“Despite a judge’s order blocking the funding freeze, we are troubled by reports that health centers are unable to access funding duly appropriated by Congress through the PMS. To compound this issue, our offices have heard troubling reports that since the Trump Administration’s executive orders and funding freeze, funding that has already been appropriated and directed by Congress is still being restricted, and standing webinars, briefings, and meetings are being cancelled at the last minute,” they wrote. “Health centers are receiving little communication regarding these cancellations and changes, and the communication they have received from HRSA has been unclear, directing actions that may conflict with current court orders.”

“Two-thirds of Virginia’s community health centers are located in the rural areas of our Commonwealth,” said Tracy Douglas, CEO of the Virginia Community Healthcare Association. “For countless hardworking individuals and families in these regions, these health centers are not just a place for medical care—they are a lifeline. People rely on them to stay healthy so they can work, care for their families, and live full, productive lives. It is absolutely imperative that we ensure the continued operation of these vital health centers to protect the well-being of our communities and our nation.”

In addition to Kaine and Warner, the letter is signed by U.S. Senators Richard Blumenthal (D-CT), Lisa Blunt Rochester (D-DE), Chris Coons (D-CT), John Hickenlooper (D-CO), Angus King (I-ME), Ben Ray Luján (D-NM), Jeff Merkley (D-OR), Jack Reed (D-RI), Bernie Sanders (I-VT), Rev. Raphael Warnock (D-GA), Elizabeth Warren (D-MA), Peter Welch (D-VT), and Ron Wyden (D-OR). The letter is also signed by U.S. Representatives Bobby Scott (D-VA-02), Gerry Connolly (D-VA-11), Don Beyer (D-VA-08), Jennifer McClellan (D-VA-04), Eugene Vindman (D-VA-07), Suhas Subramanyam (D-VA-10), and Sarah McBride (D-DE-At-Large).

The full text of the letter is available here and below.

Dear Acting Secretary Fink,

We are writing to express serious concerns regarding reports that Health Resources and Services Administration (HRSA) grantees, such as Community Health Centers (health centers), continue to experience significant delays in accessing funding to support services, as well as restrictions on regular communications with agency staff as a result of the Trump Administration’s January 20, 2025 executive orders to pause external communication from federal agencies, and subsequent memorandum directing all federal departments and agencies to freeze all financial assistance.

Community Health Centers provide high-quality primary and preventive care, dental care, behavioral health and substance use disorder services, and low-cost prescription drugs to more than 32 million Americans annually, serving one in five rural Americans and one in three people living in poverty. Nationally, more than 1,400 health centers operate over 15,000 service sites across every state and Territory, employing more than 500,000 individuals and generating nearly $85 billion in economic output.

Despite the critical role health centers play in addressing health inequities, many centers struggle to keep up with the growing demand for services and rising costs to deliver high-quality care in their communities. While nearly 70 percent of health center revenue comes from payments from Medicaid, Medicare, commercial insurance, and self-pay patients, health centers rely on their regular federal grant funding to meet payroll obligations and keep their doors open. Beginning in late January, health centers started reporting issues accessing the Payment Management System (PMS) – getting “locked out”, being denied funding they had been awarded, and experiencing long delays in funding being released. As a result, health centers across the country are experiencing panic, unsure how to pay their staff and keep their doors open. Due to delays in funding, health centers have reported:

• “We have put off signing a contract to replace our mammography machine, which has reached end of life, because of this freeze and the uncertainty.”
• “I'm also now getting providers asking if they should be looking for a new job. Without any understanding and guidance, I'm pretty limited with how much I can actually assure them to do other than tighten our belts…”
• “Any services that are directly funded by federal funds will be placed on hold…”
• “We had to use all reserves in 2024. We will not make payroll or any other payments next week without access to this federal funding. Staff will be dismissed without access to federal funds.”
• “If everything stays the same…the best guess is that we could be fully operational for six months.”
• “We have the ability to sustain current or full operations for 60 days…Outreach and case management staff…would be in the first wave of layoffs. Unfortunately, those positions rely on federal support as they are typically not reimbursable through third-party payors. In a short period of time, this has had a profound impact on our staff. [Staff are] concerned that we will lose valuable staff members as they are concerned about the stability of the organization.”
• “We will step back on hiring and likely implement hiring pause unless this is resolved quickly.”
• “We have enough in reserve to cover two payroll periods.”
• “The pause in grant funding would create a deficit for us...We would likely need to start reducing staff and healthcare services to the…patients we serve…within the next couple of weeks if the freeze persists.”

As safety net providers operating on razor-thin margins, health centers need certainty to provide care in underserved communities. In Virginia alone, ongoing delays in accessing funding have caused health centers to close their doors and cancel patient appointments. When health centers close, people with chronic conditions miss appointments, pregnant women miss prenatal visits, and behavioral health services are interrupted, worsening outcomes and increasing costs to the entire health care system.

Despite a judge’s order blocking the funding freeze, we are troubled by reports that health centers are unable to access funding duly appropriated by Congress through the PMS. To compound this issue, our offices have heard troubling reports that since the Trump Administration’s executive orders and funding freeze, funding that has already been appropriated and directed by Congress is still being restricted, and standing webinars, briefings, and meetings are being cancelled at the last minute. Health centers are receiving little communication regarding these cancellations and changes, and the communication they have received from HRSA has been unclear, directing actions that may conflict with current court orders.

We request that you provide answers to the following questions in writing no later than Wednesday, February 12, 2025.

1. How many health centers have draw-down requests pending in the PMS?
   1. How has that number changed, daily, since January 27, 2025?
   2. What is the average wait time from submission of a draw-down request to disbursement of funds prior to January 27, 2025 and after January 27, 2025?
2. How many health center draw-down requests have been denied since January 27, 2025?
   1. What is the rationale for these denials?
3. What is the exact timeline for ensuring the PMS is fully operational and disbursing all pending health center draw-down requests?
4. What specific authority and under which executive action did HRSA or the Department of Health and Human Services use to restrict health center access to the PMS and funding that they had been previously awarded?
5. Please provide a list of regular standing calls or meetings between HRSA staff and HRSA grantees that have been cancelled since January 20, 2025. Please include the following:
   1. A description of the grantees impacted, including the type of grantees and number of grantees.
   2. Whether funds appropriated by Congress for the purpose of the grant are being withheld from being awarded to the grantees.
6. Please provide a list of webinars, briefings, information sessions, and trainings that have been cancelled since January 20, 2025. Please include the following:
   1. A description of the purpose of each webinar, briefing, information session, or training.
   2. Whether or not the webinar, briefing, information session, or training is required by statute and if so, provide the corresponding citation.

Sincerely,

###