Amid financial difficulties, the Boston Health Care for the Homeless program is laying off staff and closing one of its facilities.

According to a spokesperson for unionized staff at the BHCHP, the organization announced the layoffs of 25 staff members effective Oct. 10.

At a Sept. 23 rally outside the program’s South End headquarters, staff said the layoffs will hurt the patients whom the organization serves. The nonprofit provides medical care and case management to nearly 10,000 individuals experiencing homelessness in and around Boston each year.

The 25 layoffs include recovery coaches and case managers who often serve as the first line of defense, helping patients to get off the street and connecting them with services.

“I ask the question, what does taking away quality health care look like?” said CC Williams, a 30-year BHCHP staff member at the rally. “It looks like losing case managers, who I love working with, and recovery coaches, who are vital.”

Patients who spoke at the rally said that the program’s recovery coaches and case managers have been an important resource, available to answer phone calls at a moment’s notice and give them the “real truth.”

“It brings us down; it takes us off the ledge,” said Fernando, a BHCHP patient. “No one else can do that.”

The Boston Health Care for the Homeless Program said the cuts are necessary as the organization faces “one of the most difficult financial periods in our 40-year history,” according to a statement provided by a spokesperson.

“We have had to make the painful decision to eliminate some positions. These decisions were made only after a thorough review and with deep appreciation for the dedication and service of the affected staff,” the statement said.

Staff said they worry the most recent changes could significantly impact patients. They pointed to various offerings at the BHCHP that will most likely end when this round of layoffs go through.

David Reyes, a BHCHP recovery coach who is one of the staffers being laid off, said he runs a community group for Spanish-speaking patients. When he leaves, he said, the group will probably end.

Andre Groomes, another recovery coach who is also being laid off, has run a weekly group for Black patients. That group, too, may not continue past the layoffs.

In addition to the layoffs, Boston Health Care for the Homeless Program is also planning to shutter the Stacy Kirkpatrick House, a medical respite facility it has operated in Jamaica Plain. The 20-bed facility has served as a place for patients experiencing homelessness to recuperate after medical care if they’re too sick to go to a traditional shelter.

The Barbara McInnis House, another respite facility BHCHP operates at its South End headquarters, will continue to operate.

“The ripple effect is what you’re going to see after [Oct. 10] and moving forward, when people are not getting the services they need,” Reyes said.

The changes come during a round of contract negotiations for the program’s union. As of the rally, staff said they were being offered a 1.25% raise, which they called “inadequate to help recruit and retain workers” as the health care sector faces a staffing shortage, according to a statement from the union.

During the rally, they called for a “decent raise” to meet the cost of living in Boston.

The layoffs and cuts come as the program braces for pending Medicaid cuts. According to the program’s website, about three-quarters of its annual budget comes from third-party reimbursements through programs like Medicaid and MassHealth.

Estimates from the Blue Cross Blue Shield of Massachusetts Foundation, published in a report Sept. 3, forecasted between 141,000 and 203,000 people across the state could lose access to MassHealth due to new — largely administrative — requirements codified by the Trump administration’s July budget reconciliation package, known through much of its legislative process as the “One Big Beautiful Bill.”

That legislation instituted new work requirements that mean Medicaid recipients must demonstrate they work 80 hours per month to be eligible for benefits. And recipients must go through the recertification process, in which they reverify that they still qualify, every six months instead of the previous one-year timeline.

In its statement, the BHCHP said that despite the financial challenges, it continues to prioritize patients and supporting staff.

“In these challenging times, we remain resolute in honoring our mission and supporting every member of our team as we strive to provide top-quality health care to those experiencing homelessness,” the program’s spokesperson wrote.

But union members said they feel the actions of the organization’s leadership mark a shift away from the program’s mission to “provide or assure access to the highest quality health care for all individuals and families experiencing homelessness in our community.”

“The employees here give 100- plus of their time to the community; the thing they love to do is to support [patients],” said Reyes. “For them to cut and lay off these people just doesn’t make sense when they say their mission is high-quality care to the community.”

BHCHP staff began the process to unionize in 2023 and officially voted to join 1199 SEIU in spring 2024. The issues at the time weren’t far from the ones they’re protesting now: a spokesperson for the union members described that unionization effort as a response to inadequate staffing, low wages and burnout.

The current layoffs, they said, are the continuation of a pattern that they describe as the program’s top leadership failing staff and the center’s patients.

“The summer of 2023 we came together and organized a union, and in March of 2024 we won,” said Astrid Mora, a BHCHP case manager, at the rally. “We won because we saw our leaders failing us and failing our patients.

Since then, their actions have only proven us right.”