How is a Texas-sized measles outbreak possible when the MMR vaccine is readily available? Reasonable responses include vaccine hesitancy and its close relative: social media misinformation. But coverage in the New York Times and the Atlantic includes another forgotten cousin: the impact of forgetting disease toll.
Something similar might happen with Montgomery Cares.
For nearly 20 years we've had a system in place in Montgomery County to make sure that people without health insurance have access to health care: Montgomery Cares. What it offers is not just accessible urgent care to patch people up but primary care that does the long, hard work of keeping people healthy. The kind of care that manages diabetes year-over-year or screens for behavioral health challenges and says, “Hey, would you like to talk to someone? I can introduce you today.”
As a community, we take safety net health care for granted because it has been so long since we've seen widespread limits on access to care. Our Montgomery Cares safety net has been quietly humming along, quietly improving annual quality measures. Our safety net health centers also served as our secret weapon during the pandemic, partnering with public health services to make sure the outbreak wasn't worse and that when vaccines were available people could actually get them. But right now, they feel a little like that MMR vaccine: like the forgotten hero.
It is hard to know what you can build a plan on right now, let alone a budget around. That's forcing hard choices and hard conversations. Of course, as a community we have to look at the resources that we have and ask where they should go. Where can they do the most good? Where is the best investment?
But we can't forget about safety net health care in the conversation. Because whether you ultimately access it or not, the safety net benefits us all.
Making sure our uninsured neighbors have access to vaccinations, that benefits us all with herd immunity. Making sure our uninsured neighbors don’t have to rely on emergency departments for primary care, that keeps the already-long emergency room wait times from getting longer for everyone. We’re fortunate in this community to have somewhere for our uninsured neighbors to go—our Montgomery Cares health centers. We just have to keep these health centers open.
Something similar might happen with Montgomery Cares.
For nearly 20 years we've had a system in place in Montgomery County to make sure that people without health insurance have access to health care: Montgomery Cares. What it offers is not just accessible urgent care to patch people up but primary care that does the long, hard work of keeping people healthy. The kind of care that manages diabetes year-over-year or screens for behavioral health challenges and says, “Hey, would you like to talk to someone? I can introduce you today.”
As a community, we take safety net health care for granted because it has been so long since we've seen widespread limits on access to care. Our Montgomery Cares safety net has been quietly humming along, quietly improving annual quality measures. Our safety net health centers also served as our secret weapon during the pandemic, partnering with public health services to make sure the outbreak wasn't worse and that when vaccines were available people could actually get them. But right now, they feel a little like that MMR vaccine: like the forgotten hero.
It is hard to know what you can build a plan on right now, let alone a budget around. That's forcing hard choices and hard conversations. Of course, as a community we have to look at the resources that we have and ask where they should go. Where can they do the most good? Where is the best investment?
But we can't forget about safety net health care in the conversation. Because whether you ultimately access it or not, the safety net benefits us all.
Making sure our uninsured neighbors have access to vaccinations, that benefits us all with herd immunity. Making sure our uninsured neighbors don’t have to rely on emergency departments for primary care, that keeps the already-long emergency room wait times from getting longer for everyone. We’re fortunate in this community to have somewhere for our uninsured neighbors to go—our Montgomery Cares health centers. We just have to keep these health centers open.
The Primary Care Coalition (PCC), the Montgomery Cares Advisory Board, and the Healthcare Leadership Council, which represents our partner safety net health centers, made a joint request to the County Executive for higher Montgomery Cares reimbursement in the FY26 operating budget. The requested rate--$175/visit—was based on an objective benchmark using common procedural codes for actual primary care visits and comparing to the Maryland Medicaid fee schedules, which showed an average of $250 per visit.
But Montgomery Cares is a system built to be a win-win partnership among the government and nonprofit sectors, with the local government providing a core budget that gives nonprofit partner clinics a reliable income source for their organizational stability. Stability allows them to be high-quality health centers that also fundraise, rather than fundraising organizations that happen to provide healthcare.
In this win-win partnership, the reimbursement rate target endorsed by the County Department of Health and Human Services (DHHS) was $175/visit—or 70% of the estimated Medicaid cost for services. The plan—supported by the DHHS and the 2023 County Council—was to move the then-$76.50/visit to the target of $175/visit via a phased approach. The first increase went into effect for the FY24 budget year, bringing the rate to $102.15/visit.
However, in the FY25 county operating budget, the council did not fund any increase in Montgomery Cares reimbursement rates, despite an increase to approximately $125/visit being included in the County Executive’s recommended budget. The council indicated there were more pressing demands. This year’s FY26 County Executive recommended operating budget includes an increase of ~$10/visit. It’s not enough of an increase, but it’s something. Something that may still be sacrificed in another hard budget year.
The problem is that after years spent surviving public health emergencies and low reimbursement rates, partner health centers are already running on fumes. In some ways, sharing that (authentic) message over the last few years is part of the problem, because officials see the system survive (through aggressive grant seeking, individual fundraising, and no small amount of hard work and luck) and think the problem isn’t real. But the health centers are not crying wolf, and this over-reliance on fundraising, or running deficits, cannot continue.
But Montgomery Cares is a system built to be a win-win partnership among the government and nonprofit sectors, with the local government providing a core budget that gives nonprofit partner clinics a reliable income source for their organizational stability. Stability allows them to be high-quality health centers that also fundraise, rather than fundraising organizations that happen to provide healthcare.
In this win-win partnership, the reimbursement rate target endorsed by the County Department of Health and Human Services (DHHS) was $175/visit—or 70% of the estimated Medicaid cost for services. The plan—supported by the DHHS and the 2023 County Council—was to move the then-$76.50/visit to the target of $175/visit via a phased approach. The first increase went into effect for the FY24 budget year, bringing the rate to $102.15/visit.
However, in the FY25 county operating budget, the council did not fund any increase in Montgomery Cares reimbursement rates, despite an increase to approximately $125/visit being included in the County Executive’s recommended budget. The council indicated there were more pressing demands. This year’s FY26 County Executive recommended operating budget includes an increase of ~$10/visit. It’s not enough of an increase, but it’s something. Something that may still be sacrificed in another hard budget year.
The problem is that after years spent surviving public health emergencies and low reimbursement rates, partner health centers are already running on fumes. In some ways, sharing that (authentic) message over the last few years is part of the problem, because officials see the system survive (through aggressive grant seeking, individual fundraising, and no small amount of hard work and luck) and think the problem isn’t real. But the health centers are not crying wolf, and this over-reliance on fundraising, or running deficits, cannot continue.
The safety net is our community’s herd immunity, and we don't necessarily notice when it starts to thin. Slowly, vaccine hesitancy goes up, and coverage goes down. Experts warn we’re below the threshold, but everything feels mostly fine. Things hum along, until they don't. In a matter of days, our first detected case can explode into an outbreak.
We are seeing the safety net thin. A sudden surge in newly uninsured residents dropped from Medicaid rolls is not a challenge they can absorb. We are hearing clinics say privately that they're struggling—not all of them, but some. We've seen even large FQHCs undergo strategic reorganization to get ahead of possible Medicaid reductions. These are all signs we may be losing the herd. The system as we’ve known it cannot hold much longer, and the emergency is now.
We know there are many emergencies out there. The good news is, we are an incredible community, and we can do this. But we have to do it together.
Our partner health centers know this is a tough budget year and fiscal prudency is essential, but it cannot be a flat year either. (As anyone reliant on cost-of-living adjustments knows, flat is actually another loss.) They need enough of an increase to keep going. They need a promise they're not forgotten: that they are working in partnership, not alone.
This article has not been reviewed or approved by the Montgomery County Department of Health and Human Services.
We are seeing the safety net thin. A sudden surge in newly uninsured residents dropped from Medicaid rolls is not a challenge they can absorb. We are hearing clinics say privately that they're struggling—not all of them, but some. We've seen even large FQHCs undergo strategic reorganization to get ahead of possible Medicaid reductions. These are all signs we may be losing the herd. The system as we’ve known it cannot hold much longer, and the emergency is now.
We know there are many emergencies out there. The good news is, we are an incredible community, and we can do this. But we have to do it together.
Our partner health centers know this is a tough budget year and fiscal prudency is essential, but it cannot be a flat year either. (As anyone reliant on cost-of-living adjustments knows, flat is actually another loss.) They need enough of an increase to keep going. They need a promise they're not forgotten: that they are working in partnership, not alone.
This article has not been reviewed or approved by the Montgomery County Department of Health and Human Services.
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