If the theme of the fiscal year (FY) 26 advocacy season was uncertainty, the theme of FY27 may well be emergency. And that matters for how we think about our budget asks. We have long since passed the impending doom phase and are well into the storm. This is not business as usual.
Liza Greenberg, our director of workforce capacity, hosted a table at the WorkSource Montgomery job fair last week—an experience she described as “sobering.” Where many of the past WSM job fairs she has attended have been a good fit for PCC’s focus on recruiting entry-level healthcare trainees, this last fair was very different. “Ninety percent of attendees were laid off federal workers and contractors, many with master’s degrees and PhDs,” she reported. “The Montgomery County Human Resources team at the table next to me was swamped with a line the entire three hours.”
This was not your mother’s job fair. The experience confirmed what many of us know intuitively: the economic hardship is real and widespread. And that’s before we see substantial spillover from direct layoffs.
That means two things for safety net budget requests:
If the safety net had been funded at true cost for years, we might simply forgo a standard budget ask in favor of tightening our collective belts. But that is not our reality. Long-term underfunding has left little room to pull back now. We do not have the resources to meet growing community needs without additional funding support. It is not a viable option, no matter how committed healthcare for the uninsured providers are.
Imagine suggesting a calorie deficit for two individuals--asking each of them to exercise harder while eating the same or less. Now imagine one of those people has a BMI of 25 and one has a BMI of 15. The former might be reasonable. It would almost certainly be absorbable. The latter is dangerous. So is continued underinvestment in our safety net.
The asks we are considering are not expansive. They do not substantively raise salaries or revolutionize our ways of practice. They simply add capacity where it is already stretched—before a likely wave of newly uninsured residents with little or no income.
Consider increased reimbursement rates for Montgomery Cares (MCares) providers, who have no other mechanism to adjust for inflation.
The true cost benchmark for primary care visits established by MCares partners is $250/visit. That figure is based on an estimated average cost for primary care services when it was established in FY23. The target reimbursement endorsed by the Montgomery County Department of Health and Human Services was set well below that—at $175/visit or 70% of the cost of care. That middle ground offered a reasonable amount of stability to nonprofit providers while maintaining a good value proposition for the County. But we have yet to reach that benchmark. The approved FY26 increase brought the reimbursement up to $113/visit. Put another way, the County has yet to meet a target that has already been outpaced by inflation. Any rate below $175/visit is still playing catch up.
PCC has also identified additional Montgomery Cares support needs to add capacity where the system is insufficient to support the current patient load, such as needs for additional vaccine and specialty care service funding, and staffing to support program demand.
None of these requests are luxury spending. They are system maintenance. Essential primary care for the safety net.
Liza Greenberg, our director of workforce capacity, hosted a table at the WorkSource Montgomery job fair last week—an experience she described as “sobering.” Where many of the past WSM job fairs she has attended have been a good fit for PCC’s focus on recruiting entry-level healthcare trainees, this last fair was very different. “Ninety percent of attendees were laid off federal workers and contractors, many with master’s degrees and PhDs,” she reported. “The Montgomery County Human Resources team at the table next to me was swamped with a line the entire three hours.”
This was not your mother’s job fair. The experience confirmed what many of us know intuitively: the economic hardship is real and widespread. And that’s before we see substantial spillover from direct layoffs.
That means two things for safety net budget requests:
- They are likely to be more challenging than ever as the projected revenue base shrinks, and
- They are more important than ever to keep our community whole.
If the safety net had been funded at true cost for years, we might simply forgo a standard budget ask in favor of tightening our collective belts. But that is not our reality. Long-term underfunding has left little room to pull back now. We do not have the resources to meet growing community needs without additional funding support. It is not a viable option, no matter how committed healthcare for the uninsured providers are.
Imagine suggesting a calorie deficit for two individuals--asking each of them to exercise harder while eating the same or less. Now imagine one of those people has a BMI of 25 and one has a BMI of 15. The former might be reasonable. It would almost certainly be absorbable. The latter is dangerous. So is continued underinvestment in our safety net.
The asks we are considering are not expansive. They do not substantively raise salaries or revolutionize our ways of practice. They simply add capacity where it is already stretched—before a likely wave of newly uninsured residents with little or no income.
Consider increased reimbursement rates for Montgomery Cares (MCares) providers, who have no other mechanism to adjust for inflation.
The true cost benchmark for primary care visits established by MCares partners is $250/visit. That figure is based on an estimated average cost for primary care services when it was established in FY23. The target reimbursement endorsed by the Montgomery County Department of Health and Human Services was set well below that—at $175/visit or 70% of the cost of care. That middle ground offered a reasonable amount of stability to nonprofit providers while maintaining a good value proposition for the County. But we have yet to reach that benchmark. The approved FY26 increase brought the reimbursement up to $113/visit. Put another way, the County has yet to meet a target that has already been outpaced by inflation. Any rate below $175/visit is still playing catch up.
PCC has also identified additional Montgomery Cares support needs to add capacity where the system is insufficient to support the current patient load, such as needs for additional vaccine and specialty care service funding, and staffing to support program demand.
None of these requests are luxury spending. They are system maintenance. Essential primary care for the safety net.
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