If state and federal funding trends regarding Medicaid and pharmacy discounts continue, "we will see major negative impacts on our community," Dr. Griggs said.
Waco’s safety net for low-income patients is facing “dire” threats due to state and federal decisions, Waco Family Medicine’s top executive told the Waco City Council on Tuesday.
The nonprofit clinic system has cut staff 12% and closed three clinics since 2024, while facing continued challenges due to tightening Medicaid eligibility and issues with pharmacy discounts, said CEO Dr. Jackson Griggs.
“If funding continues to go the way that it has in the last couple years, in the way at least that we’re seeing federal policy go now, we will see major negative impacts on our community,” Griggs said.
Waco Family Medicine is a Federally Qualified Health Center, meaning that it is able to make its services affordable to low-income patients through high Medicaid reimbursement rates and drug discounts.
Griggs explained how pharmacy middleman companies, called Pharmacy Benefit Managers, had “wedged” themselves into the network’s drug purchasing process, driving up prices. Texas legislators have chosen not to regulate those managers, he said.
Meanwhile, the Texas Legislature’s 2023 decision to discontinue automatic Medicaid enrollment drastically reduced enrollment in that program locally, meaning the clinic has to serve more uninsured patients.
The City of Waco pays some $1.25 million a year to offset the clinic’s cost of serving the uninsured, with a smaller match coming from McLennan County.
Of some 75,000 patients Waco Family Medicine has seen over the past 12 months, 29% were uninsured, costing the clinic more than $10 million. Meanwhile, 31% of patients had Medicaid and 13% had Medicare.
“This will continue to happen if we are not proactive, if we continue to let the state continue to cut, if we let the federal government continue to undermine safety net programs, we will continue to shrink,” Griggs said. “Fewer and fewer services will be provided to our neighbors.”
The decline in state and federal support is already affecting service, Griggs added, noting increased phone response times and longer travel for outlying patients receiving radiology services.
Waco Family Medicine serves McLennan, Hill and Bell counties, though the majority of patients are Wacoans.
Griggs bullet-pointed several ongoing and future risks to the network’s finances, including pharmacy middlemen, deep future Medicaid cuts embedded in the “One Big Beautiful Bill” passed this summer and new federal policies “undermining” the 340B program, which allows safety-net providers such Waco Family Medicine to purchase medications at a discount.
Waco Family Medicine was established in 1969 by the McLennan County Medical Society to improve primary care services for low-income residents.
“We’ll do everything we can do to keep fighting, to keep our doors open,” Griggs said.
