Christine Mertzelos is trying to avoid having her leg amputated.

Twice a week, a hospital van carries her from her home in Wrigleyville to the wound clinic at Humboldt Park Health, where a diabetic ulcer on her ankle is cleaned, treated and dressed. At one point, the ulcer wrapped nearly all the way around her lower leg — a situation that can lead to amputation if not controlled. The ulcer, however, has shrunk significantly.

“This place has been a lifesaver for me,” said Mertzelos, 61. “Without this clinic I don’t know what I would do.”

She and others, however, are worried they may have to find out in coming years. The recent signing of the “One Big Beautiful Bill” has thrown into question the future of services at safety net hospitals like Humboldt Park Health that care for large numbers of people on Medicaid.

The new law will slash an estimated $1 trillion from Medicaid over the next 10 years to help pay for tax cuts and enhanced border and national security, according to the Congressional Budget Office.

Humboldt Park Health will likely see an additional $5 million to $7 million in losses annually once the changes go into effect, said CEO Jose Sanchez. The hospital typically has an operating margin of about $1 million annually.

“I came in this morning and met with senior leaders and said, ‘We’ve got to begin to think about how do we position ourselves to face the potential cuts we’ll have,’” Sanchez said earlier this week.

About 75% to 80% of Humboldt Park Health’s patients are on Medicaid, and the hospital employs about 1,000 people, he said.

“When you absorb the magnitude of those cuts, that means now you are beginning to make a decision of what services you are not going to provide,” Sanchez said. “When you eliminate services, you eliminate people as well.”

As a state, Illinois stands to lose about $48 billion in federal funding for Medicaid over 10 years, according to KFF, a nonprofit organization focused on health policy.

More than 330,000 Illinois residents — or nearly 11% of those now on Medicaid — are at risk of losing their health care coverage over the decade, according to Manatt Health, which provides legal and consulting services in health care.

New work requirements for certain adults on Medicaid don’t go into effect until late December 2026, and major changes to provider taxes — a mechanism states use to help fund their Medicaid programs — won’t take effect until fiscal year 2028. But hospitals aren’t waiting to start making plans.

“Undoubtedly the hospitals can’t wait until the policies are fully implemented,” said Dr. Ben Sommers, a professor of health policy and economics at Harvard T.H. Chan School of Public Health. “They need to start planning now.”

Patient Maria Fuentes worries about what will happen if Humboldt Park Health has to cut its offerings. Fuentes has been going to the hospital, which was previously called Norwegian American Hospital, for decades, and gave birth to all four of her kids there.

“It’s my hospital,” said Fuentes, 52, of Dunning, as she visited on a recent day for a checkup.

Sinai Chicago will also face difficult decisions in coming years as the law’s provisions take effect. Sinai, which includes Mount Sinai Hospital on the West Side and Holy Cross Hospital on the South Side, has been running in the red, and about 70% of its patients are on Medicaid, said CEO Dr. Ngozi Ezike.

It’s too early to say exactly how much money Sinai will lose as a result of the new law, but “going forward there will be services that will have to be adjusted,” Ezike said.

“There are a lot of things that will have to be looked at, including layoffs, everything that we don’t want to do, those are all things that have to be on the table,” Ezike said.

Cook County Health also expects to take a hit, including a loss of about $88 million a year once the work requirements go into effect, with an estimated 10% of its Medicaid patients potentially losing coverage, said CEO Dr. Erik Mikaitis. Many people are expected to lose Medicaid not because they don’t qualify, but because of increased paperwork-related challenges.

Cook County Health isn’t planning on any layoffs or service changes for now, as it works through a projected budget gap for 2026, Mikaitis said. But in coming years, “the more that things happen, the more likely there may be a time we’ll have to make difficult decisions,” Mikaitis said.

Mostly, he worries about how the new law will affect patients who may lose their health coverage.

“As people lose coverage they stop engaging in preventative care, and instead of seeing patients in the office to manage blood pressure and diabetes, we’re going to see them in the emergency room to manage strokes and heart attacks,” Mikaitis said.

Lurie Children’s Hospital also sees potential trouble ahead. About half of Lurie Children’s Hospital’s patients are on Medicaid. Though those patients are children and won’t be subject to work requirements, hospital leaders worry about how other cuts to federal Medicaid dollars for Illinois might affect its offerings.

The hospital is already limited by the gap between what Medicaid reimburses it for services versus what that care actually costs to provide, said Lurie CEO Dr. Tom Shanley. The question, he said, is, “Are we going to be able to continue the degree of the services we have today as we move forward?”

As Mertzelos finished her treatment at Humboldt Park Health on a recent day, she wondered aloud what would happen to people like her if the hospital had to cut its offerings.

“It literally scares me to hear something like services might be cut because I don’t know what I would do,” Mertzelos said.

Dr. Ann Marie Kulekowskis, who is medical director of the hospital’s wound clinic, overheard her.

“I don’t know what we would all do,” the doctor replied.

_____

©2025 Chicago Tribune. Visit chicagotribune.com. Distributed by Tribune Content Agency, LLC.