SF LGBTQ health agency plans for future under Trump

by Meg Collins, Thursday, September 4, 2025
Source: Bay Area Reporter (https://www.ebar.com/story/157714/News/SF%20LGBTQ%20health%20agency%20plans%20for%20future%20under%20Trump)

Staff at the San Francisco Community Health Center never stop moving, and certainly haven't since the beginning of the Trump administration's second term in January. Since H.R.1, also known as the One Big Beautiful Bill Act, was signed into law by President Donald Trump on July 4, staff have not only seen an increase in anxiety and uncertainty, but have also had to invest more labor in ensuring their clients continue to be enrolled in their health coverage.

The Bay Area Reporter had a chance to see the center's operations and speak with several staff members and a patient at its Tenderloin Wellness Center on August 19 and 21. 

Several staff members expressed anxiety and stress they've seen from their patients, as well as personal unease they have for their patients' health and safety.

Eli Benway, a queer trans person who uses they/them pronouns, is the health care facility's associate director of behavioral health. When speaking with the B.A.R. in person on August 21, they said that they'd noticed more anxiety coming from their trans clients, in particular. 

"There’s been a lot of higher stress being reported, and folks are experiencing a lot of hopelessness, feeling justifiably more targeted," Benway said. They explained that almost all the clients they work with are on the San Francisco Health Plan, and clients worry that this plan will be terminated.

Other staff members echoed those concerns.

"I think everyone is waiting for our trans folks to be kicked off of their coverage. It just hasn't happened yet. Everyone's nervous,” said Taylor Cuffaro, a trans nurse practitioner who heads the Street Medicine program at the center. 

"Insurance doesn't dictate whether or not you can use a medication; it just dictates whether or not they will pay for it,” added Cuffaro, who uses they/them pronouns. “I know at the CHC it's a priority to keep people on hormones, but theoretically, a health care organization could stock these medications, except for testosterone, because testosterone is a controlled drug." They added that they fear that organizations with the financial ability to supply people with testosterone will not have the clearance from the federal Drug Enforcement Administration.

Ro Van Sloun, a queer and nonbinary staffer who uses they/them pronouns, is one of the health center’s Street Medicine case managers. 

"People are picking up 'I don't feel safe. I don’t feel welcomed here. I feel like I'm denied services.’ People are sensing that things are getting darker," said Van Sloun, in conversation with the B.A.R., perched on a chair at their desk, with a “crisis phone,” a phone for staff to reach out when they need support with a client’s crisis.

Robin, who asked that her last name not be published, is a patient at the health center. We were not able to confirm how she identifies in time for publication. Robin emphasized that the center will continue to take care of its community, regardless of federal constraints. She remembers first meeting her case manager, Van Sloun, who came to see her with a team of people and no judgment.

“The Community Health Center makes it so that you want to get clean. You want to do the right thing,” said Robin. “They care here. They look at you in the eyes and they know your name.” 

Rence Uson, a transgender straight woman, is the health eligibility access liaison for the health center. She clarified the center's assistance with ensuring its patients' enrollment in Medicaid with H.R. 1's restrictions on eligibility requirements with the B.A.R. over email. Her work involves connecting people with the right resources for their needs.

“I make sure these benefits are put into good use and stay accessible through the process of enrollment and quality improvement,” wrote Uson in an email.

She noted, in a statement to the B.A.R., that the new requirements for H.R. 1 will translate to additional labor. The center is already hiring more people to be part of the eligibility team, and training current staff to check for eligibility and patient registration.

Dr. Daniel O’Neill, a gay man, is the chief medical officer of San Francisco Community Health Center. He clarified while the B.A.R. visited that Federally Qualified Health Centers, which the health center is, receive many sources of funding. The San Francisco Community Health Center has a $27 million annual budget.

"If people aren't enrolled in Medicaid, then we don't get paid for the care. When we send off labs, they go to our laboratory, and then we get a bill from the laboratory that goes to our bottom line and our ability to keep our doors open, if people aren't covered," O'Neill said.

"Clinicians want to prescribe this medication and check those labs. But there's no way to pay for it," said O'Neill, emphasizing that the new law intends to push people off their insurance. "Providers want to deliver care to keep people healthy, right? Anyone and everyone who walks through our door. Increasingly, we are having to spend all our time managing these new constraints that are coming our way."

While H.R. 1 presents many concerns, chief among them is the approximately $75 billion in extra funding allocated to Immigration and Customs Enforcement, while much of Medicaid is being restricted.

Health policy expert Dr. Theresa Cheng, a straight woman and ally, spoke with the B.A.R. about H.R. 1 and its impacts. Cheng is an assistant clinical professor of emergency medicine and associate co-director of social emergency medicine at UCSF, as well as an emergency medical physician at Zuckerberg San Francisco General Hospital and Trauma Center. She told the B.A.R. that H.R. 1 will have profound impacts on everyone, stripping essential resources from "some of the most vulnerable people of our population," but also that the law has "profound ramifications for the entire U.S. population." Cheng referenced the Congressional Budget Office's estimates that the law will take health insurance away from 17 million people.

In a phone interview with the B.A.R., Cheng spoke about SFGH. 

"It is our safety net hospital. All emergency departments are open 24/7 for this reason, particularly when at San Francisco General, we are there to serve low-income, vulnerable patients who have nowhere else to go,” she said. “I am just horrified to see what is coming down the pipeline, and I'm genuinely scared for my patients."

For many health care providers, immediate concerns are the cuts to Medicaid and increased constraints on eligibility that the bill presents, particularly with new work requirements to qualify for Medicaid. According to an article for the Center on Budget and Policy Priorities by Elizabeth Zhang and Gideon Lukens, they wrote that effective January 1, 2027, the law will require states to deny coverage to people applying to Medicaid if they are not already working at least 80 hours per month, and will terminate Medicaid for people already enrolled if they can't document that they meet these work requirements. This exempts caregivers of dependent children aged 13 and below, people with disabilities, people who are pregnant, and several other groups. Though according to findings of the CBPP, much of the loss from these work requirements will happen to people who should qualify but will lose access to Medicaid due to red tape.

The CBPP had previously reported that in 2018-2019, Arkansas had implemented work-reporting requirements similar to those in H.R.1 – requiring adults with low incomes to report 80 hours of work each month to keep Medicaid coverage. In the first seven months of this new requirement, 18,000 people lost coverage, with very few regaining coverage the following year.

H.R. 1 is more stringent than the Arkansas work requirements. While the Arkansas work requirements applied to adults aged 19-55, the new federal law applies to adults aged 19-64. The new law also redetermines eligibility every six months. When states can't verify that individuals meet the work requirements or the exemption criteria, they must issue a "notice of noncompliance." Individuals have 30 days to show compliance; the state will disenroll them from their coverage.

Diana Lieu, who did not get back to the B.A.R. on how they identify, is the communications manager of the San Francisco Community Health Center. She clarified the status of federal funds, telling the B.A.R. in an email that because of the center being a plaintiff in the Lambda Legal Defense and Education Fund lawsuit, the center’s federal grants are still intact. They continued that the agency has to be vigilant and advocate for all funding streams, not all from federal sources, which would be similar to any year for the nonprofit health care provider. 

As the B.A.R. reported, a federal judge blocked the Trump administration from defunding the nine plaintiff nonprofits. Lambda Legal announced in July that $6.2 million in federal funding was restored to the nonprofits.

The lawsuit, which is ongoing, challenges Trump’s Executive Order No. 14168 about gender identity that defines sex as “an individual’s immutable biological classification.” The suit also challenges Executive Orders Nos. 14151 and 14173, terminating equity-related grants and blocking the implementation of diversity, equity, inclusion, and accessibility principles in federal contractors and grantees’ work. 

Pivoting to care management
As a result of this ongoing budget uncertainty, the community health center is pivoting to Enhanced Care Management, or ECM, which is a Medi-Cal managed-care benefit program under the California Advancing and Innovating Medi-Cal initiative that was launched in California on January 1, 2022. Services are provided in-person, at homes, shelters and doctors’ offices by ECM providers, such as case managers, community health workers and nurses, as well as a lead care manager who organizes aspects of care between physical, behavioral, dental, developmental, and social support. O’Neill added, over email, that historically this case management has not been reimbursed through Medicaid but has been funded by less reliable grants, many of which are now threatened or discontinued. Enhanced Care Management provides more reliable reimbursement for essential health services.

“These are all kinds of things that patients need support with,” O’Neill said, adding that they’ve had to get “very creative and reevaluate all the different roles.”

The San Francisco Health Plan is the version of Medi-Cal local to San Francisco, which is available to low-income city residents. Medi-Cal is California's Medicaid program. The reconciliation law, or H.R.1, presents new strict work requirements for Americans to be enrolled in the plan.

Regardless of attacks at the federal level, the center remains a special place for both patients and staff. When asking Eli Benway about how it feels to do their work, which includes regularly supporting both patients and staff with loss, trauma, and mental wellness, they said it feels wonderful. 

"I spend most of my time outside of work on my self-healing so that I can just hold people: imperfectly, but just the best I can," Benway said.

Other staff, including O'Neill, expressed similar sentiments, passionately advocating for their patients' well-being. O'Neill added that community health centers need support to do life-saving work.

"Support community health centers,” he said. “In this moment, we are literally on the front lines. Federally Qualified Health Centers have always been in the trenches."


For more information about the San Francisco Community Health Center, visit sfcommunityhealth.org .