KFF Health News CELO COMMUNITY, N.C. — On a 15-degree morning in January, a clinic in the Appalachian Mountains of North Carolina began to fill up with patients. An older couple in flannel pajamas sat together in the waiting room. A toddler waved as Patricia Hall walked past him, a stethoscope draped over her neck. The family physician waved and smiled back. But in the privacy of a conference room, her mood shifted. She is often bogged down with paperwork and can’t get patients timely appointments with specialists. She also fears that a health care worker shortage affecting her clinic — and many others across the nation — will only get worse. Hall’s clinic, the Celo Health Center, is one of seven locations that make up the Mountain Community Health Partnership, which was supposed to receive up to $10 million over the next decade through Making Care Primary, a federal program to improve primary care, especially in rural areas, by providing payments for physicians to address patient needs. Her organization planned to use the money to hire staff, build better connections with local specialists, and fund vehicles to shuttle patients to appointments, according to its CEO, Tim Evans. Then, in March, clinic administrators received an email during the Department of Government Efficiency’s whirlwind of federal cuts: The Centers for Medicare & Medicaid Services would soon shutter Making Care Primary, a year into what was supposed to be a 10-year program. Nearly 700 practices in eight states enrolled in Making Care Primary. North Carolina had 23 clinics and centers in the program, the most of any state, followed by Washington, New Mexico, and New York. Doctors who had signed up for it said they were stunned. ‘I’m angry, but more than that, I am so very sad,’ Hall said. ‘It’s heartbreaking — to have an already inadequate health care system be made even more inadequate, to throw away opportunities to improve, even a little.’ Now, CMS’ Innovation Center, which created Making Care Primary, is set to launch a new 10-year program to boost primary care called the Long-term Enhanced ACO Design, known by its acronym LEAD. In that program, funding will be sent to health care organizations, often managed by companies, instead of directly to primary care doctors and clinics. CMS wouldn’t say how much the programs cost. But it maintained that eliminating Making Care Primary reduced spending without sacrificing its mission to improve quality of care. Nixing Making Care Primary and three other programs at the agency — including another focused on primary care — would save taxpayers $750 million, CMS said at the time. Patricia Hall is chief medical officer at Mountain Community Health Partnership in western North Carolina. Tim Evans is the CEO. Last year the federal government revoked a promise of up to $10 million in funding for their operation. Credit: Andrew Jones / KFF Health News Making Care Primary ‘was not on track to meet its intended savings goal,’ CMS spokesperson Alexx Pons said. Innovation Center models are meant to save money over time, in part by improving patients’ access to health care and helping them avoid costly hospital visits. Practices that signed up for Making Care Primary and want to join LEAD will have to apply for the program beginning in March. Yet Making Care Primary’s elimination has created skepticism among doctors. The change exacerbated their fears about uncertain funding overseen by the Trump administration as COVID-era Medicaid provisions expired, enhanced Affordable Care Act subsidies ended, and Congress passed more funding cuts in President Donald Trump’s One Big Beautiful Bill Act. William Hathaway, a physician