A federally funded health care center in central Iowa has terminated core care for its transgender patients for fear of losing federal funding, four sources have confirmed.
In a letter sent to transgender patients receiving hormone replacement therapy, and obtained by the Iowa Capital Dispatch, Primary Health Care stated in February it would no longer provide hormone replacement therapy care “(d)ue to a recent Executive Order restricting use of federal grant funds from being used for gender-affirming care.” PHC in the letter told patients that should the health center be “out of compliance” with the order, it would risk losing “critical” and “significant” funding.
A former PHC employee, who spoke with the Iowa Capital Dispatch on the condition of anonymity, said PHC’s executive team told employees the health center risked “losing millions of dollars in federal grant funding for the homeless support services” if it continued gender-affirming care. The Iowa Capital Dispatch granted anonymity because the former employee feared potential repercussions from PHC.
A transgender advocate and another person with knowledge of the change, both of whom spoke to Iowa Capital Dispatch on the condition they not be identified, also confirmed that PHC had ended gender-affirming care.
Primary Health Care is a federally qualified health center, which means it receives funding from the federal government through the Health Resources and Services Administration under the U.S. Department of Health and Human Services. FQHCs were created in the early 1990s to serve as safety net providers. They care for underserved populations. PHC is one of 14 in the state.
Representatives of Primary Health Care and Iowa Primary Care Association, which provides broad support for Iowa’s FQHCs, did not respond to repeated questions that were posed to executives, board members, and physicians during multiple weeks of outreach.
The former employee said staff at PHC were “begging” the executive team to figure out different funding methods for the clinic in order to keep providing gender-affirming care.
“The basis of Primary Health Care and the Project is the queer community … and how could we possibly continue to be that if we’re telling part of that population that (they) don’t belong (at PHC)?” the former employee said.
Only one other federally qualified health center in Iowa responded when asked whether other care centers were following PHC’s lead in terminating care for transgender patients. Chad Wolbers, chief executive officer at Crescent Community Health Center in Dubuque, said that’s not happening at his health centers. When asked if Crescent Community currently has transgender patients, Wolbers said, “Yes we do. We take care of all that present to us in need of care.”
Consulting firm cites confusion over executive orders
A principal with FQHC Associates, a consulting firm for FQHCs nationally, acknowledged the confusion over federally funded health care centers’ ability to provide gender-affirming care to patients. Steve Weinman pointed to two executive orders President Donald Trump signed in the early days of his administration.
One executive order deals with stopping transition care for children and teenagers through 18 years of age. The other executive order, which Trump signed the day he took office, is meant to “defend women’s rights” and “recognize women are biologically female, and men are biologically male.” In doing so, the Trump administration takes aim at gender ideology and the “false claim” of being able to change one’s sex. Through that lens, the executive order directs agencies to “end the Federal funding of gender ideology” and that “Federal funds shall not be used to promote gender ideology.”
The U.S. Department of Health and Human Services told the Iowa Capital Dispatch that less than two weeks after the signing of that executive order, the Health Resources and Services Administration sent an email to its federal funds recipients that they must stop their programs related to “gender ideology” for “people aged 19 and younger.” Five days later, HRSA sent another email to tell recipients its previous “notification had been rescinded.” HHS told the Iowa Capital Dispatch that “Health centers continue to provide care to Americans who face challenges in accessing quality healthcare.”
When asked why PHC still moved to stop gender-affirming care when the federal agency told FQHCs to ignore its previous mandate, the former employee at PHC said that’s “the big question, and that’s what staff wanted to know. Why? Nothing is law…The only thing that we were being told is that they were scared to lose the federal funding that they had. Which, the amount of federal funding that they get for homeless support is a huge chunk.”
Lawmaker calls decision ‘deeply disappointing’
State Rep. Aime Wichtendahl, a Democrat of Hiawatha and the first transgender legislator elected to Iowa’s Legislature, said PHC’s decision to terminate hormone replacement therapy care is “deeply disappointing.”
She said “an executive order is not law. It is not force of law. And what the Trump administration is doing, withholding federal funds, is a violation of both the law and funds that Congress has appropriated.
“If the federal pressure has been removed, then they should immediately restore services and health care to trans patients. There is no justification for cutting off access to health care,” Wichtendahl said.
One patient who said she received hormone replacement therapy care at PHC’s University Avenue location said she felt “like all hell was breaking loose” when she learned about PHC’s decision. “It felt like the sanctuary that I had was kind of just crumbling beneath me. It was quite heart wrenching because I do love going to my doctor.” The patient requested to remain anonymous.
She said her provider at PHC was also emotional about the decision to terminate hormone replacement care. The former employee echoed that and said, “everyone seemed to be pretty emotional about the decision that had been made.” Not only was PHC stopping gender-affirming care, but the former employee claimed staff also had to remove or cross-out pronouns on their ID badges and business cards.
The messaging around PHC’s decision to end gender-affirming care was carefully managed, according to the former employee. The executive team at PHC handed staff a script with suggested responses to likely questions that patients or people wanting to establish care may ask. There were at least six potential questions and corresponding answers, according to a staff handout the Iowa Capital Dispatch reviewed.
PHC’s decision, made at the same time as Republican legislative efforts to roll back gender identity protections in the Iowa Civil Rights Act weighed heavily on both the former employee and the patient. “It’s such a common thing for trans people to not get ample HRT care, as well as HIV care. Not having good resources for that, it just really sucks,” said the patient.
Wichtendahl said now is the time for the transgender community to make its voices heard “and say you’re not taking away our health care.”
“We will make that demand that they restore those services,” she said.