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February 18, 2025

CT hospitals brace for immigration, gender-affirming care changes

CLOE POISSON / CTMIRROR.ORG Saint Francis Hospital main entrance on Woodland Street in Hartford.
By Katy Golvala, CT Mirror

Since President Donald Trump took office in January, he’s issued a flurry of executive orders directly impacting U.S. health care, and Connecticut’s hospitals have been racing to keep up with the onslaught and understand their implications. 

The president’s directives aimed to slash the funding that research institutions receive through the National Institutes of Health, and they have peeled back Biden-era guidelines that extended the enrollment period for Affordable Care Act plans and established experiments aimed at saving money on prescription drugs. 

“This is probably the most chaotic period of time that I can recall for health care providers,” said Joan Feldman, chair of health law at the Hartford law firm Shipman and Goodwin.

Hospital leaders are most immediately concerned about the impacts of federal policy changes to immigration enforcement and gender-affirming care for children, according to health care insiders. But they’re also keeping an eye on potential cuts to Medicaid that could have sweeping effects on hospitals’ financial stability. 

Executive orders

Top of mind at many hospitals is a Trump executive order rescinding guidelines limiting immigration arrests at “sensitive locations,” including schools, churches and hospitals. The protections had been in place for over a decade and were reinforced by the Biden administration in 2021. 

The change presents multiple challenges for hospitals, said Paul Kidwell, senior vice president at the Connecticut Hospital Association. First, it creates a situation where people might avoid getting necessary care and, second, it requires hospitals to train front-line staff how to interact with immigration enforcement. 

“That’s a new expectation for someone whose job is not related to immigration,” Kidwell said.

Kurt Barwis, the president of Bristol Hospital, said last week that his team created explicit guidance for staff regarding what to do if Immigration and Customs Enforcement shows up at their facility.

“We just sent that around to all the physicians and staff to make sure everybody knows exactly how to handle that situation,” Barwis said.

In the event that immigration officials show up, Barwis’ team instructed front-line staff to request necessary credentials and warrants and to immediately notify the hospital’s compliance team. Guidelines also state that no patient can leave the hospital until they’ve completed their course of treatment.

Connecticut provides Medicaid-like state-sponsored coverage regardless of immigration status to children 15 and under, as well as people who are pregnant or postpartum, who have qualifying incomes. Barwis said he’s heard from physicians, and OB-GYNs in particular, who are concerned for the health and safety of patients who might hesitate to seek care.

Kidwell said that, to his knowledge, ICE hasn’t yet shown up at a Connecticut hospital. 

Trump’s executive order that would, if enacted, withhold federal funding from institutions, including medical schools and hospitals, that provide gender affirming-care to kids is also creating concern among institutions providing that type of treatment. 

As of last week, two judges had paused the order.

Feldman, the health care attorney, works with hospitals, community-based mental health providers, substance use recovery programs and federally qualified health centers and said she’s seen a “mixed bag” of responses from clients that provide gender-affirming care to kids. Some are waiting to see how agencies will implement the executive order before making changes to the care they offer, while others are already starting to refer children receiving gender-affirming care to other providers.

“You don’t want to jeopardize funding for all of the care you receive for a small number of patients compared to the total population,” Feldman said. “However, as a health care provider, you can’t abandon patients. So you have a duty to figure out — if you can’t provide the service — if there’s another provider that can.”

Medicaid cuts

Beyond executive orders, hospitals are also laser-focused on potential changes to federal funding of Medicaid, which would have massive consequences to their balance sheets, Barwis said.

Republicans in Congress have been looking for ways to cut spending to extend tax cuts passed in Trump’s first term, which are set to expire in 2025. A budget resolution advanced by the House Budget Committee last week directs the Energy and Commerce Committee, which oversees Medicaid, as well as energy and climate programs, to cut spending by $880 billion. Many believe Medicaid could take a major hit. 

“The easiest lever for them to pull to get the biggest number is the Medicaid program,” Barwis said.

Federal subsidies that helped expand access to health insurance on state marketplaces are set to expire after 2025 unless Congress renews them. House Republicans have also reportedly considered changes to Medicaid financing that could significantly reduce how much the federal government pays to states, including imposing a per capita cap on federal Medicaid spending, reducing the federal match rate that states receive and imposing Medicaid work requirements.

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