Swope Health CEO Jeron Ravin will look back on 2025 as a “cascading nightmare.”

After the Trump administration froze or canceled millions of dollars in public health grants in January, it cut dollars designated for things like vaccines for children, infectious disease tracking and community health work, and discontinued funding for organizations it determined didn’t match its political ideology.

“Three years ago the only word you heard was health equity,” Ravin said. “Now you can’t even discuss it without some concern that your organization will end up being at risk.”

The turmoil that marked the year that’s ending probably won’t let up in 2026, health care leaders in the Kansas City area warn. If anything, it may get worse.

In addition to the lost government funding that health care organizations are struggling to absorb, future cuts are likely and they are bracing for a major loss of revenue in coming years as the country’s uninsured population soars. 

New Medicaid rules passed in July could force more than 5 million people off health coverage. And the Dec. 31 expiration of premium tax credits that subsidized Affordable Care Act marketplace insurance could compel another 5 million people to drop insurance.

The resulting decline in revenue combined with the financial burden of caring for more patients who can’t afford to pay — and are probably sicker as a consequence — sets up a difficult situation for safety-net providers in 2026. And the toll on people’s health will reverberate across Kansas City’s nonprofit health care ecosystem.

“I think it’s going to be a devastating year for our sector,” said Brenda Sharpe, CEO of the REACH Healthcare Foundation. “Ultimately, the folks who will be hurt the most will be people who are already vulnerable.”

There won’t be enough help in the private sector

According to an October study by the Urban Institute, 33% of nonprofits, including health care and other sectors, reported at least one type of federal funding disruption this year; 27% experienced a delay, pause or freeze; 21% reported losing some funding; and 6% reported getting a stop work order.

The study found that federal funding disruptions spilled into state and local government grant programs. And even organizations that do not receive government money felt the sting.

“There are ripple effects that reached across the entire fundraising and funding landscape,” said Laura Tomasko, who leads the Urban Institute’s Center on Nonprofits and Philanthropy. 

That’s because having fewer government dollars available sent more organizations to the private sector seeking help. But the gap created by canceled federal funding won’t be easily replaced, experts said.

“Typically the scale and scope of government funding cannot be made up by typical individual donations or foundations,” Tomasko said.

Sharpe said that is certainly true from her vantage point. The REACH Foundation, which provides grants to health-related nonprofits in six counties in Missouri and Kansas, saw a surge in requests this year — far more than it could meet.

Health care organizations still reeling from the COVID pandemic and the expiration of COVID-related support faced major budget gaps that came unexpectedly and suddenly. At the same time, as inflation stayed high and safety-net programs like SNAP teetered, the need for their services grew.

“Unfortunately, (federal funding cuts) are so extensive,” Sharpe said, “private philanthropy can’t possibly cover that gap.”

Finding other ways to survive

The REACH Foundation is looking for other ways to help. That might mean working with organizations to find another nonprofit that will share overhead or administrative costs. It could also mean nonprofits merging to cut expenses.

Already, Sharpe said, organizations the REACH Foundation supports have been forced to cut staff, shrink coverage areas or pare back services. And she expects that to happen more often in 2026.

“When you add everything up, it’s completely unprecedented,” Sharpe said, “and very discouraging. The only bright side I see is the nonprofit sector is so creative, so resilient and so resourceful, they’re trying their best to meet the moment and we’re trying to walk beside them. But there’s only so much we can do before the system just breaks.”

The upheaval has forced many nonprofits to rethink how they will approach funding moving forward. Even in health care, government funding is no longer a sure bet. 

Medicaid, which has long helped subsidize the free care provided by safety-net providers like Swope Health, is up in the air. Ravin said his organization expects to lose $5 million to $12 million in Medicaid revenue next year. And grant funding at every level of government, including Kansas City, is in question. 

“Almost every aspect of public health that advances health outcomes for the region is under attack,” Ravin said.

Health care leaders agreed that turning to philanthropy to make up the losses isn’t a long-term fix.

“It has got to be a piece of the puzzle,” said Doug Day, chief marketing and development officer with KC CARE, another safety-net health clinic. “But if nonprofits think the private sector is going to swoop in and take care of all of this, there’s going to be a rude awakening.”

Nonprofit health providers need to look for ways to be more self-reliant, by increasing earned revenue, Day said. To that end, KC CARE is trying to attract more kids and pregnant women as patients because Medicaid for those populations is less at risk. The clinic is also expanding dental services early next year, which it hopes will mean more revenue.

But Ravin said it’s not realistic to believe that safety-net clinics can counter all the cuts by attracting different patients or providing certain services.

“That’s just not the way health care works,” he said. 

The bigger priority, he said, has to be on keeping patients covered so that the expected gap in Medicaid revenue is as narrow as possible.

How safety-net clinics are coping

Swope, KC CARE, Samuel U. Rodgers and other safety-net clinics known as federally qualified health clinics, rely on Medicaid patients — and the higher reimbursement rate they get for treating them — to subsidize care for patients who can’t pay.

In Missouri, Medicaid is known as MO HealthNet. In Kansas, it’s called KanCare.

But a budget bill that President Donald Trump signed last summer puts Medicaid coverage at risk for millions of people. Starting in 2027, most adults who don’t have a disability will have to submit regular proof that they have worked or volunteered at least 80 hours a month if they aren’t enrolled in school. The Congressional Budget Office estimates that the requirement could lead to 5.3 million people becoming uninsured by 2034.

The law will also add more frequent eligibility checks for people to keep Medicaid, which will also cause people to lose coverage.

Kansas City-area clinics said they are ramping up efforts to help Medicaid patients meet the new requirements. This includes providing assistance with filing paperwork and, for the 20% of Medicaid recipients not already working, finding volunteer opportunities.

Sam Rodgers CEO Bob Theis said some Kansas City-area community organizations and churches are also making efforts to help.

“We don’t want anyone to fall through the cracks,” he said. “We need to figure it out, and we need to figure it out for our communities so fewer people roll off of Medicaid.”

The community as a whole needs to worry about growing numbers of people without insurance, he said. In addition to patients losing Medicaid, another 5 million could lose insurance through the ACA marketplace next year.

People who lack health insurance are less likely to seek routine care. That means they’ll often end up in emergency departments with conditions that are more dangerous and more expensive to treat. And that drives up costs for everyone, Theis said.

“All these changes added together … it is scary,” Theis said. “I don’t know what’s going to happen, but we have to do something.”