The Impact of Medicaid Cuts on Infection Prevention and Public Health

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Medicaid funding plays a crucial role in supporting infection prevention programs, vaccination initiatives, and access to essential health care services for vulnerable populations. However, with proposed Medicaid cuts amounting to $800 billion, health care experts are raising concerns about the devastating effects these reductions could have on hospitals, community programs, and overall public health. In an exclusive discussion, Niobis Queiro, MBA, CEO of the Queiro Group, and Imamu Tomlinson, MD, MBA, CEO of Vituity, provide insights into how these budget cuts could significantly impact infection prevention efforts, exacerbate workforce shortages, and increase the spread of infectious diseases.

This discussion underscores the urgent need for policymakers to consider alternative strategies to mitigate the impact of Medicaid reductions and protect public health efforts nationwide.

ICT: With Medicaid facing a potential $800 billion cut, how might reduced funding impact infection prevention programs in hospitals and other health care settings?

Niobis Queiro, MBA: The good news is that hospitals are dedicated to infection prevention; this is evident during the blackout of information from the CDC. Hospitals nationwide are united by communicating infectious disease data and outcomes within their markets.

We are concerned about the increased financial strain that will impact facilities. Many hospitals and outpatient programs serve Medicaid and Medicare populations that will not be compensated for said services, but the need does not go away. This will create a gap in services. There is great concern about research for infectious diseases that have been halted or limited due to the impending cuts. In summary, there are 3 areas to watch in this situation: financial impact to deliver care with limited funding for the Medicaid population, resource (staffing/supplies/transport to care) limitation due to financial impact, and research gaps for infectious diseases.

Imamu Tomlinson, MD, MBA: Potential Medicaid cuts will diffusely affect hospital operations. Hospitals, especially nonprofit hospitals, operate at very narrow margins. Further squeezing those margins will leave hospitals and health care providers in the difficult position of choosing where to cut. Oftentimes, community programs are the first programs to be cut. Many of those programs are frontline immunization, education, and public health programs.

Hospitals serve as the communities' safety net, which could be more difficult with cuts. For example, immunizations in underserved communities are often done through Medicaid-funded programs. Without these programs, some areas may have outbreaks of diseases we haven't seen in years, like measles and chickenpox.

ICT: What challenges will hospitals and health care organizations face in maintaining infection control measures if Medicaid funding is significantly reduced?

NQ: Health care budgets are 80% human resource driven. Not all hospitals will be impacted the same; it truly depends on their geographic area and payer mix. The areas that will be greatly impacted will be urban and rural communities. This is where we see the highest number of Medicaid patients and areas already struggling with health care deserts. The first area that will be impacted is vaccinations; for example, COVID-19 vaccines have not been supplemented in 2024-25, and hospitals have stopped requiring them for their employees and are promoting them to patients due to the cost. The cost of vaccination will make it prohibitive for low-income children to get them without Medicaid funding. Hospitals rely on government programs that supplement cost and access for infectious disease control. Keeping programs open will be difficult, and expanding services is a thing of the past. Policy requirements will be difficult to achieve without the funding designation to keep our population safe from infectious disease.

IT: As mentioned, the cuts could have a diffuse impact. I believe hospitals and health systems are very vigilant about maintaining sterile environments and have very stringent infection control measures. That said, every system has its limits. Limiting funding could lead to labor and supply shortages that could affect those processes.

ICT: How could the budget cuts affect access to essential vaccinations, screenings, and treatments for infectious diseases among vulnerable populations?

NQ: The reason we have such quality awareness of infectious disease, vaccination, screening and treatment programs was due to the investment in population health through the Medicaid program. Every notice, program notification, vaccine, and treatment program are supplemented by the Medicaid program to achieve a healthy population.

Infectious disease control comes into play with school entrance requirements and some preemployment health screenings. These efforts are supplemented financially by the government and are in jeopardy of being slashed by pending cuts. Hospitals and clinical programs are neither funded nor equipped to manage or deliver these programs without government funding support. There will be serious hard decisions that will have to be made, and the only hope will be private donations to save our population’s health.

IT: Many underserved communities rely on Medicaid for much of their primary and preventative care. As with the measles example, limiting access to those services could potentially increase health care costs and lead to outbreaks in some communities. In this case, school-age children are the most at risk if there were to be limited immunizations or well-child checks as a result of cuts.

ICT: Many infection prevention efforts rely on staff training and resources. What are the risks of workforce shortages or reduced infection control education due to financial strain?

NQ: Programs will close. We must get innovative about our training methods. This is the silver lining. We will have to lean into AI to train our workforce. We can use ambient AI agents to monitor and support in-time training for the staff. The cost is less than in-person training, and it delivers higher efficiency. Hospitals are adopting this model quickly due to the scarcity of training resources and the performance efficiency it delivers. Yes, we have a large population of clinical staff that is aging out, as is true in all industries. There will be an anticipated reduction in staff, and as people leave, they will not be replaced. There will be a major strain in providing the population with adequate information and training. This is where we will see philanthropic efforts increase to support the care and well-being of the American people at the grass-roots level and within health care systems.

IT: We already have a pretty significant workforce shortage across health care, so less support will only make things worse. I believe hospitals may have to leverage other technologies or outsource services to accommodate that workforce reduction. However, that gap will likely be too wide to bridge with other creative measures.

ICT: Emergency rooms already face overcrowding—how could Medicaid cuts exacerbate the spread of infectious diseases in these high-risk environments?

NQ: Public health is at an all-time crisis in America. The USDA (ERS) has reported that 146 rural hospitals stopped providing inpatient services from 2005 to 2023 in the United States. We have health care deserts that have patients traveling over 100 miles to get care. When people are limited in their access to care or have financial limitations for care, they fail to seek care, and we will return to high comorbid condition rates, and patients will only go for care when they are on their deathbeds. The spread of infectious disease is sure to rise, and the inability to control the disease processes due to lack of herd immunity will rise. We already have an example of this in the measles outbreak we are experiencing in Texas, New Jersey, and Kentucky due to high rates of vaccine exemptions and the mobile nature of this country.

IT: As we saw with the pandemic, health care locations can be locations where infectious disease spreads. With cuts, more people could use the emergency department as their primary entrant for care. From an infectious disease standpoint, emergency departments are high risk. So bringing more health patients seeking primary care options to the emergency department could lead to inadvertent outbreaks.

ICT: What policy or health care strategies could help mitigate the impact of Medicaid cuts on infection prevention and overall public health?

NQ: Serving as part of a leadership team at a public health hospital, I can say that the way to make this work is through grassroots community alliance. In Nashville, the local churches aligned with Nashville General have supported diabetes and High blood pressure management in their community. Health Systems will need to align with their communities to care for their communities. They will need to establish coordinated care models that communicate across neighborhoods, churches, and cultures. This is a time of unity to keep our people alive and well. We have good policies, and they are being stripped away. We need to stand up and create the necessary change in a unified manner.

IT: Any health care cuts without a plan will lead to worsened outcomes. If there were other resources, policies, or funding for primary and preventative care, that may offset broad Medicaid funding cuts. Also, there could be private sector opportunities to bolster those programs and income prevention. We could also benefit from a policy that could enhance access to care in primary care environments—especially in areas with limited options. Those kinds of policies may help decompress emergency departments.