The Massachusetts State House. At a legislative briefing May 19, leaders from community health centers across the state presented three bills to legislators that they said would help support the network of centers and their patients.

Health center leaders used virtual briefing on May 19 to push for legislative priorities backed by the Massachusetts League of Community Health Centers, the nonprofit organization that coordinates with and advocates for the state’s 50 health centers. That organization is advocating for steps to grow Massachusetts’ primary care workforce as well as for bills that would protect monetary savings for the providers.

The legislative advocacy day comes as community health centers across the state face mounting financial pressures amid a shifting political landscape.

“We’re facing some pretty daunting challenges,” said Michael Curry, president and CEO of the Mass League. “The cost of care is going up, access to care is challenged. I would argue quality of care is being compromised and our system is under attack from the federal government.”

Curry said that between changes to Medicaid, which is one of the main sources of revenue for community health centers, the loss of the premium subsidies that helped offset insurance premiums, up to 300,000 Massachusetts residents could lose access to insurance, a churn that he said he expects to disproportionately impact community health centers.

That threat of reduced revenue also comes as health care costs have been steadily rising and federal policy around health centers shift.

Given the landscape, legislators at the briefing touted the impact of health centers in Massachusetts.

“You’re the first line of treatment, and you don’t turn folks away based on their status, based on their language, based on their income, based on any need other than their basic health care needs,” said Rep. Daniel Cahill. “That’s something Massachusetts should be proud to continue to provide, but that does come at a cost.”

Supporting education through Medicaid

For community health centers, expanding access to primary care is a priority that health center staff said can improve health across the board. Research has found that increased access to primary care providers can improve population health and health equity while lowering healthcare expenditures. Those benefits can be especially impactful in communities that have faced health access gaps previously, said Dr. Renee Crichlow, medical director at Codman Square Health Center in Dorchester.

“One of the biggest things that we’re trying to put in place is the idea that primary care is a priority, not just for access, but for health equity,” said Crichlow, who serves on the state’s primary care task force, a group established under state law in January 2025 to study and provide recommendations to increase access.

But the profession itself is in trouble. According to a 2024 report by the Association of American Medical Colleges, by 2036 the United States could face a shortage of up to an estimated 40,400 primary care physicians.

Susan Levine, CEO of Lowell Community Health Center, said a dearth of primary care physicians is the reality across the healthcare system, but that it is especially acute in community health centers.

One proposed bill included in the list of the Mass League’s legislative priorities would aim to increase the state’s primary care workforce, especially in community settings. That bill would opt the state into an existing federal program called Medicaid Graduate Medical Education (GME), which allows states to direct Medicaid funding to medical education providers to support the training of new physicians, by repurposing $4 million from a separate federal program that allows states to test pilot initiatives through their Medicaid programs.

Massachusetts is one of only seven states to not allow for Medicaid funds to support the training in the state but doing that — particularly by allowing for the training of physicians at community health centers — would help expand primary care workforces in the communities that need it most, Levine said.

“Medicaid GME allows community-based healthcare organizations … to train future primary care physicians in the communities where they are needed absolutely the most,” Levine said.

“When residents train in community health centers, they are far more likely to stay and practice in those communities.”

She pointed to the Greater Lawrence Family Health Center, which was the first in the country to launch such a training for medical residents and has been doing so since 1994.

As of 2025, the Greater Lawrence program had trained almost 250 residents, more than half of whom stayed in Massachusetts.

Over half of the clinicians currently at the health center also went through the program.

“That’s what it looks like when physicians are trained in the community, with the community, and for the community,” Levine said.

Protecting pharmacy savings

Also on the radar of the Mass League is a bill that would work to protect a source of savings for health centers. Under the federal 340B drug pricing program, community-based health providers and safety net hospitals can purchase medications from drug manufacturers at discounted rates.

Those saved dollars are then reinvested back into patient care, said Maria Celli, CEO of Brockton Neighborhood Health Center. At Brockton Neighborhood Health Center, that means money supporting staff who coordinate referrals, interpreter services costs, transportation costs for patients and health benefits counselors who help patients apply for and access insurance.

“These are not extras,” Celli said.

“These are mission-critical services that help patients stay healthy, contributing to their communities and engaged in their lives.”

Savings through the 340B program have been weakened in recent years, she said, as manufacturers have created restrictions on relationships with outside pharmacies. Even when health centers operate their own pharmacies, they often contract with other pharmacies that might be more accessible or otherwise preferred by patients. In recent years, she said, drug manufacturers began to restrict access to the discounted pricing through those partnerships as well.

“The result is fewer savings, less flexibility, and less support for the essential services that our patients count on every day,” Celli said.

The landscape is also complicated by pharmacy benefit managers, who operate as middlemen in the network of drug manufacturers, pharmacies and insurers.

The pharmacy benefit managers have faced criticism for reducing competition, which can lead to higher insurance premiums for patients and lower reimbursement to pharmacies.

The proposed legislation at the State House would add new restrictions on additional fees or requirements for 340B-eligible providers.

Commercial insurance equity

The Mass League is also advocating for legislation that would require commercial health insurance plans to reimburse community health centers at a rate equivalent to MassHealth. Currently, commercial insurance plans on average pay $135 less per visit compared to the state’s Medicaid program, said Bethany Kieley, CEO at Community Health Programs in Berkshire County.

For Community Health Programs, equivalent reimbursement rates would net an additional $4 million annually, something she said would “meaningfully impact” the health center by allowing for better recruitment and retention of staff as well as maintenance of the health center’s facilities.

Health center leaders said the reimbursement legislation, along with the other bills supported by the Mass League, will help support health centers as they weather for a more challenging financial landscape.

“The safety net can only stretch so far before it snaps,” said Thomas Statuto, senior vice president of government affairs and public policy at the Mass League.

Impacts to the centers could be felt across the sector, Statuto said, as patients who rely on the services risk lower access to care. He said the state is at an inflection point that could further burden the emergency medicine system and increase health inequities.

“We know that rising tides lift all boats,” Statuto said. “Protecting access for our most vulnerable residents, while doubling down on our commitment to address health inequities, will lead to a stronger health care system, and more importantly, healthier communities.”