For decades Gateway Healthcare and the Samuels Sinclair Dental Center have provided behavioral and dental care services to thousands in Rhode Island.

The two organizations, however, face an uncertain future as Brown Health is considering closing them to cut costs.

Advocates worry that closures would cut access to care for thousands of vulnerable patients.

PROVIDENCE – Brown University Health is considering closing Gateway Healthcare, the state’s largest nonprofit behavioral health care provider, and the Samuels Sinclair Dental Center, the state’s primary provider of dental care for children and people with special needs, in an effort to rein back costs.

The closure of the two facilities would have a vast impact on Rhode Island’s health care system, advocates say, by cutting access to vital services for vulnerable patient populations.

Brown Health, the state’s largest health system, has been mulling the decisions since at least May, according to an internal memo from CEO John Fernandez obtained by The Journal.

Besides closing Gateway Healthcare and the Samuels Sinclair Dental Center, Brown Health is also considering halting facility projects at Rhode Island Hospital, reducing adult inpatient psychiatric services, stopping labor and delivery services at Newport Hospital and cutting contracts for some state programs.

“These are difficult measures, given the vital role these services play. But rising costs – from competitive wages to essential technology and facility investments – require us to plan for different scenarios to preserve our mission,” Fernandez’s memo said.

Brown Health is still evaluating its budget for fiscal year 2026 and has yet to announce any decisions, according to a statement sent by Jess Wharton, a spokesperson for the health system.

“Our priority remains protecting our core mission, and we expect to provide more details in the coming weeks,” the statement said.

The decisions were predicated on whether the General Assembly would approve a $90 million Medicaid increase, which when matched by federal funds would increase to $270 million, the memo stated. Rhode Island lawmakers did increase Medicaid rates by $15 million from state funds – totaling about $40 million with the federal match – plus $38 million for hospital reimbursement rates and direct support payments.

Between 2012 and 2024 – except for 2020 and 2021, when hospital finances were boosted by pandemic relief funds – Brown Health operated on an average margin of about $6 million a year, according to figures provided by Wharton.

That is below the health system’s target of a 3% margin – though Brown Health did not provide dollar figures for that margin, for how big the financial gap is in this year’s budget nor for how much it would save by closing Gateway Healthcare and the Samuels Sinclair Dental Center. But according to Brown Health’s report for fiscal year 2024, Gateway Healthcare reported a loss of more than $5 million.

Stalwarts of behavioral and dental care

Both Gateway Healthcare and the Samuels Sinclair Dental Center have long histories and are stalwart providers of behavioral and dental care in Rhode Island.

Gateway Healthcare’s origins date back to the 1960s, according to a history from Brown Health. In the decades since, it grew into a network of community mental health centers, and in 2013 it became affiliated with Brown Health.

Gateway Healthcare has locations in Pawtucket, Johnston and Charlestown. Besides behavioral health care, Gateway Healthcare also offers a host of social services, among them substance abuse treatment, bereavement counseling, family shelters and autism programs through other organizations that are affiliated with it or merged under its umbrella.

The organization employs more than 600 staffers, among them psychiatrists, psychologists and clinicians. It serves more than 25,000 Rhode Islanders each year.

Part of the challenge is that behavioral health and substance abuse services are reimbursed at lower levels than other medical specialties, said Linda Hurley, head of CODAC, a nonprofit that provides similar services.

“We’re never sustainable to the point that if we stub our toe twice in one fiscal year, we are not in trouble. There’s just not enough compensation,” Hurley said.

But closing Gateway Healthcare could result in primary care offices being inundated with patients, said Jen Etue, director of integrated behavioral health at Open Door Health, a clinic in Providence. And it would come at a time when Rhode Island is seeing an increase in need for behavioral health care services.

A closure would be “pretty catastrophic for the state of Rhode Island,” Etue said. “This is going to stretch an already pretty thin system even thinner.”

Losing Samuels Sinclair would be ‘unspeakable’

The Samuels Sinclair Dental Center similarly has a long legacy in Rhode Island. It was founded nearly a century ago – in 1931 – according to a Brown Health history. It is now the oldest and largest dental care practice in the state for people with special needs.

The center has about 30 staff members, among them pediatric and general dentists, residents, dental hygienists, assistants and administrative staff, according to Elizabeth Benz, director of the clinic. It sees about 19,000 patients annually; many of them have special needs.

“We are also the primary provider for all of the state’s group home patients, for intellectual disabled patients. You’re thinking autism syndrome, Down syndrome, any other syndromic things, seizure disorders, so we basically take all of those patients on as well, and there are very, very few other providers that are capable of handling that population,” Benz said.

The center also does all pre-valve clearances for cardiothoracic surgeries at Rhode Island Hospital, clears patients for head and neck cancer treatment and treats rare tooth infections. The center’s proximity to Rhode Island Hospital – it is on the hospital’s campus – is convenient for getting those clearances, Benz said, but without it patients may have to go to other sites before treatment at the hospital.

And it is one of two sites for dental residencies in Rhode Island (the state does not have a dental school). Three residents train at the Samuels Sinclair Dental Center every year, but they often leave the state after graduating.

Steve Brown, chief of service at the center, said closing it would deliver a blow to the special needs community in Rhode Island.

“Closure of this place would be devastating for the community, because there’s really no place like the Samuels Sinclair Dental Center in the state. … We are the safety net for the safety net,” Brown said.

“It’s also very shortsighted on the hospital’s part, because of all the other treatment that this place provides that no one else in the state, even in Southeastern Massachusetts, provides this level of care,” he added.

Dentists have also raised concerns over low reimbursement rates from Medicaid, leading most private practices to not accept it anymore, Benz said.

The Samuels Sinclair Dental Center, which does take some forms of Medicaid, also has the challenge that services for special needs patients may take twice as long and require twice as many staff as a regular appointment but get reimbursed at the same rate, Brown said.

Fotini Dionisopoulos, president of the Rhode Island Dental Association, said if Brown Health shuts down the Samuels Sinclair Dental Center, it would have an “unspeakable” impact on the community.

“For being such a pioneer in education and diversity and inclusivity, to shut this establishment down goes against all of the principles that they promote themselves to be, by shutting off the access of dental care to our special needs population,” Dionisopoulos said.