HYANNIS — For 15 years, despite patients’ right to abortion care in Massachusetts, it was impossible to get an abortion on Cape Cod. Then, in 2023, Health Imperatives, a nonprofit sexual and family health organization, opened a clinic in Hyannis. Although surgical abortion procedures are not offered at the clinic, it made medication abortions in the early weeks of a pregnancy an option for Cape Cod patients.

After a month of legal limbo following passage of the “Big Beautiful Bill,” however, Health Imperatives learned this month that it could no longer bill Medicaid for any of its services — whether they are related to abortion or not.

“There is an assault from the federal government on the people we serve and the programs we operate,” Health Imperatives CEO Julia Kehoe told the Independent on Aug. 11. “Today it’s Medicaid, but tomorrow it could be the loss of another federal grant.”

 

A Hit Meant for Planned Parenthood?

The Trump administration’s budget bill, which the president signed on July 4, established criteria that prohibit certain abortion providers from charging Medicaid for any services they provide.

Under the new legislation, any reproductive care clinic that provided abortions — excluding cases of rape, incest, or when a woman’s life is in danger — and billed Medicaid for more than $800,000 in 2023 is now barred from receiving any federal reimbursements.

Planned Parenthood filed suit on July 7 in federal court in Boston, arguing that Congress specifically designed the law to target it and its member clinics.

One week later, on July 14, then-Deputy Administrator and Director of the Center for Medicaid & CHIP Services Drew Snyder made a declaration to the court in which he specifically named Health Imperatives and Maine Family Planning as examples of other abortion providers that fit the criteria in the budget bill to show that the new law did not single out Planned Parenthood.

Snyder had previously announced his departure from the agency, citing family matters, and he officially stepped down on July 21, according to an agency spokesperson.

Before the Snyder declaration, Kehoe told the Independent that she did not think Health Imperatives met the conditions set out in Trump’s budget bill.

“The Trump administration has not given states guidance on how to identify and address who is impacted by this or not,” said Kehoe.

The bill states that federal payments should not go to a provider that is “primarily engaged in family planning services, reproductive health, and related medical care.”

Because only 40 percent of its clinic patients receive sexual or reproductive health care, Kehoe said, she did not think that Health Imperatives would be affected.

But after being named in Snyder’s declaration, Health Imperatives conferred with officials at Mass. Health to determine whether the law did, in fact, apply. After about two weeks, state officials told Health Imperatives that they should stop billing Medicaid altogether in early August, according to Kehoe.

“I think that Health Imperatives is in this unfortunate position of being a smaller provider who has been caught up in what is a federal dragnet,” said state Sen. Julian Cyr.

 

Making Up the Losses

Kehoe said that the funding loss will not result in a cutback of services or the closure of clinics. But it means funding will now have to come from alternative sources, including private donations and additional state funding.

Medicaid reimbursements account for approximately 20 percent of the organization’s revenues across the seven clinics Health Imperatives runs, or about $120,000 per month, according to Kehoe.

The Healey administration announced on Aug. 14 that the state had allocated $5 million in its 2025 supplemental budget proposal for reproductive health-care providers to make up for losses in federal funding.

“Even in an uncertain fiscal environment, this is not an insurmountable amount of dollars,” Cyr said on Aug. 11. Cyr, who led efforts to bring medication abortions back to Cape Cod in 2023, served on the Health Imperatives board from 2014 to 2017.

“We will do everything we can to ensure that Health Imperatives and all abortion providers in Massachusetts continue to provide care despite the very worrisome actions that are occurring in our federal government,” said Cyr.

If the state legislature approves Gov. Maura Healey’s supplemental budget proposal, Health Imperatives would likely be able to access the funding sometime in the fall, according to Kehoe.

 

Elsewhere, Lawsuits Ensue

Maine Family Planning, the other non-Planned Parenthood organization named by Snyder, took a different approach. Together with the Center for Reproductive Rights, Maine Family Planning sued the Trump administration on July 16, arguing that the federal government’s defunding of the organization violates the Constitution’s Equal Protection clause.

On Monday, a federal judge appointed by Trump during his first term denied Maine Family Planning’s motion for a preliminary injunction, preventing the organization from receiving reimbursements as the case proceeds. Without federal funding, Maine Family Planning may have to stop serving hundreds of primary-care patients by the end of October, according to the Associated Press.

In Planned Parenthood’s July suit filed in federal court in Massachusetts, a federal judge appointed by President Obama made the opposite ruling, granting the organization an injunction so that the organization can continue to bill Medicaid.

A group of Democratic-led states and the District of Columbia filed a third lawsuit in federal court on July 29 challenging the Trump administration’s efforts to defund abortion providers.

Health Imperatives has not filed suit, but CEO Kehoe told the Independent that it was “still looking at all options.”

 

Limits Are ‘Worse and Worse’

While the multiple federal cases make their way through the courts, Kehoe said that Health Imperatives faces “very difficult decisions.”

Earlier this summer, Health Imperatives laid off 11 employees in its seven clinics because of mounting employee health-care costs, said Kehoe.

“That’s really ironic that as a health-care organization that provides care to people who either can’t afford it or aren’t eligible because of immigration status, we can’t afford our own health care for our employees,” said Kehoe.

One potential solution to buoy the Health Imperatives budget is private funding. Private benefactors already subsidize costs for many patients seeking abortions in states where Medicaid funds do not pay for any abortion-related expenses. The Susan Thompson Buffett Foundation, for example, has for decades quietly given away billions of dollars to support reproductive health-care organizations, according to the Associated Press.

Although private donations may not come with strings attached, a shift away from government funding may affect the sustainability and perceived legitimacy of abortion and other reproductive health care.

“If the private donors totally took over and made it no different from Medicaid, that would be a different thing,” said Nicola Moore, a doctor who lives in Truro and travels to perform abortions in other states. “But that will not happen. There’s not enough money.”

Moore told the Independent that the restriction of abortion rights has gotten “worse and worse” in recent years.

“When the government says, ‘We’re not going to pay for it,’ the implication is that it’s not legitimate or appropriate health care,” Moore said. “It’s standard health care to be able to get a flu shot or Covid shot. It’s standard health care to be able to get an abortion when you need one.”