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Equality Health Center considers the future as previous state contract ends

  • Equality Health Center director Dalia Vidunas outside the facility on July 27. Geoff Forester / Monitor staff

Monitor staff
Published: 7/31/2021 3:00:25 PM
Modified: 7/31/2021 3:00:12 PM

Dalia Vidunas pauses when she thinks about what budget cuts to family planning funding mean for her small, longstanding practice in downtown Concord.

“Our doors are not going to close,” she said, reassuring herself from inside the repurposed 19th-century house that serves as the office for the Equality Health Center on Main Street. “What’s going to change, though, is the way we do service.”

When Gov. Chris Sununu signed the state budget on June 25, just blocks down the street from the nonprofit, family planning providers found themselves in limbo.

The two-year contracts with the state expired on June 30. The Equality Health Center received $78,400 from the state, a combination of federal and state funds to offset money lost from withdrawing from Title X funding after the Trump administration’s gag rule.

The Biden administration is working to reverse the gag rule and reinstate funding, but federal dollars likely won’t be available until the spring for providers rejoining the program.

In the meantime, there is a lapse of state funding with no contracts proposed yet and cuts to the pool of money for family planning providers. In 2019, the budget offered just over $1.5 million for contracts for program services. Now, that pool is $868,332.

A poster explaining the landmark Roe v. Wade decision decorates the wall above the stairs on the second-floor landing, a reminder of the federal right to an abortion. Despite Republican legislators’ attempt to defund these services, it won’t stop them from happening at the Equality Health Center.

Instead, it will force cuts to previously free services and staffing.

Making cuts

When free HIV testing was cut out of the state budget in 2012, Vidunas, the executive director who was newly hired at the time, found a solution. She implemented what she called an “STD special,” where patients could come to the clinic and receive a series of STD tests for $75.

It cost them $72 to run the tests, but the $3 profit and reassurance that people are knowledgeable about their sexual health was enough for Vidunas to run the program.

Ten years later, the price is up to $95, but that’s marginal compared to a hospital, where it can cost over $400 for these tests, according to Vidunas.

The special would be one of the many reduced-cost or free programs that could be cut from the clinic with a lack of state funding.

Vidunas also paints a different picture that may become a reality for the clinic. A room on the second floor is equipped with couches and chairs, not typically what you would find in a clinic, outside of a waiting room.

The space is home to counseling services, where newly pregnant patients come in to discuss plans from adoption to abortion to finding OB-GYN doctors in the area, free of cost. These conversations can take up to an hour of a health worker’s time.

“It’s truly, truly about choice, and it’s whatever is best for you, and we’re not the experts of your body in your life. You are,” Vidunas said. “We are here to give you all the information we possibly can so that then you can make an informed decision about your own life.”

If she has to raise the cost of the service, even up to $50, she knows most of her patients will not be able to afford it. For self-paying customers, which make up 30% of clients, payment is coming out of their pockets, not through an insurance provider.

The center operates a sliding payment scale that starts at 250% of the federal poverty level, and where fees are calculated based on family size and income.

“For somebody who does not have a lot of money yet finds out that they’re pregnant, are they really going to be able to pay for sitting with somebody for an hour to talk about all of their pregnancy options?” she said.

These free client-oriented services are what she prides the center on providing. There are few places in the state where you can sit down on a couch in an old house and just talk about your sexual health, she said.

Abortions account for less than half of their business. She knows the potential of scaling back services or charging fees will hurt a portion of clients that walk in the doors with abortion not even on their radar.

“We’re limiting where they can get information. We’re limiting where they can get LGBTQ services. We’re limiting all where they can get good family planning services,” she said.

Vidunas also holds up a two-sided handout illustrating each birth control option — pros and cons, descriptions, success rates and pictures are highlighted in a purple chart. Rather than handing the paper to patients and sending them on their way, they sit down and talk through each option.

Birth control conversations, as well as free pregnancy testing, could also be hit with a price tag to offset staff paychecks.

She did not have to let staff go throughout the pandemic. With fewer clients and staff working fewer hours, the books balanced out. But when a few staff members left in the last year, she has yet to replace them.

“We have been short-staffed for over a year now,” she said.

Now she’s advertising one position, but only part-time. In reality, there are two full positions that should be filled, but no money to fund them.

“I only have one up, because I don’t know if I can afford both. And the one that we have is not a full-time position, because I don’t know if we can afford that,” she said.

Limiting choices

Vidunas was not surprised that funding cuts and abortion restrictions, like mandating ultrasounds and banning abortion after 24 weeks, were proposed in the State House. She has seen Republican legislators attempt this for years. But she was surprised Sununu signed off on the budget.

“New Hampshire is supposed to be about choice. And you’ve taken that choice away,” she said.

And passing these rules through the state budget, where the legislative process differs from that of proposing a bill, also blindsided her.

“Instead of going through the normal legislative process where people get to actually voice their concerns, for or against, submit testimony and do all kinds of wonderful things, they threw it into a budget. It’s frankly very sneaky,” she said.

“It’s just not open. That’s not how governments should run.”

In the past, the budget has helped the center. In 2019, after family planning providers withdrew from Title X funding over the Trump administration’s gag rule, the budget served as a savior, funding the lost federal dollars. Now, family planning providers are in limbo as a result of new budget protocols.

On June 30, the two-year contracts providers had with the state expired.

“We’ve been continuing family planning services through the month of July with no payment,” she said. “We’re still providing that full array with no dollars to back up to help with staffing. It’s going to be it’s very costly. And plus, we know that we’re going to be severely reduced.”

Now the budget proposes a financial audit before a new contract is discussed, which could delay state funding further in the interim. This is to ensure that family planning providers are not using state or federal dollars on abortion services.

The Executive Council will meet in August, and Vidunas hopes that they will discuss these contracts for providers. Funding will be allocated based on the number of patients each provider saw pre-pandemic, she was told.

She is also unsure what the financial audit prior to the contract will entail.

“With this new law, we don’t know, are they going to go by the current standards that are being used? Are they going to be made tougher?” she said. “We absolutely have no clue what are they going to do. And that’s nerve-racking when you’re going to be up for a financial audit, and you don’t know what they’re auditing and how they’re auditing.”

As she waits for federal funding, she knows she has to keep her doors open, whether that means charging for services, making cuts or doing more fundraising events.

If Vidunas has to pivot and start charging for services, she’ll look to insurance providers for estimates for reimbursements.

Regardless, the center has to carry on and adapt to keep helping patients, she said.

“We’re just such a beacon of light for so many people. I always tell people we’re the tiny clinic that could,” she said. “We’re tiny but mighty.”

But even if the clinic shrinks in the meantime, Vidunas has no plans to shut doors or move from the house where an original poster from their 1974 founding hangs in the doorway. The proximity to the State House provides a dichotomy between a lack of funds and an expectation of services.

“This location, it’s great. Because what it does is it shows that we’re here and we’re proud,” she said. “We may change services a little bit, but we’re not gonna go away.”

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