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This story was originally published by ProPublica.

This past June, Ashley Voss-Barnes received a court summons in the mail.

PrairieStar Health Center, a nonprofit community health center in south-central Kansas, was suing her for $675 and her wife for $732 in unpaid medical bills. Voss-Barnes knew the clinic received federal funding to make preventive health care accessible in a region where many families, including her own, needed financial help.

She didn’t understand what led to the lawsuit. She and her wife had a blended family of five kids that cost a lot to keep healthy. As a result, years ago, the couple had asked PrairieStar if they could set up an ongoing payment plan to automatically take money from their checking accounts multiple times a month. Voss-Barnes would later state in a court filing that PrairieStar never informed her those payments were not enough to cover her bills and keep her out of collections.

“If I have something due, then I will try to pay it,” she said to ProPublica. “It came out of nowhere.”

Voss-Barnes, a nurse who feels confident navigating the health care system, wanted to push back. She reached out to a local lawyer to see if he could represent them, but he said the debt was too small to be worth it. So she represented herself, filing a letter in court objecting to the lawsuit and asking to continue the existing payment plan.

Eventually, Voss-Barnes and her wife agreed to set up new payment plans with the collections agency for the debt, to avoid having the money taken directly from their paychecks through wage garnishment. To their dismay, they owed hundreds more in interest, court costs and lawyer fees as a result of PrairieStar’s decision to sue.

They worry about PrairieStar suing them again. “I know we’re not the only ones this has happened to,” Voss-Barnes said.

The lawsuits against the two women are among at least 1,000 that PrairieStar has filed against patients since 2020 for unpaid medical bills, according to a ProPublica analysis of state court records over that period. Many patients PrairieStar sued were uninsured and made so little money they qualified for discounted care, a former patient accounts employee told ProPublica.

Community health centers like PrairieStar Health, also known as federally qualified health centers, were created to serve as medical safety nets for people who struggle to afford primary care. They were established during the Civil Rights Movement-era “War on Poverty,” when federal officials realized that low-income Americans, overwhelmed by long drives and crowded hospitals, were forgoing medical attention. The health centers receive federal grants in exchange for serving patients regardless of their ability to pay, increasing access across large swaths of the country.

But ProPublica found that several of these health centers are suing patients and garnishing their paychecks — which experts say contradicts their mission. We identified two other centers in Kansas, plus one in rural Virginia and one in Kalamazoo, Michigan, that consistently filed lawsuits against patients since at least 2020. Our search, which was not exhaustive, focused on states and counties where court records are publicly accessible online. We also reviewed documents from a municipality in Alaska and a county in California that run community health centers, which showed they use outside debt collectors to pursue what patients owe.

Leaders of five community health centers, including PrairieStar, told ProPublica they send patients to collections or file lawsuits against them as a last resort, after sending statements and offering payment plans. Three pointed to the financial instability that community health centers face as a reason to pursue patient debt. All five stressed that they did not turn away patients who could not afford medical care, citing a goal to make health care accessible.

In response to questions from ProPublica, PrairieStar CEO Bryant Anderson said that the health center faces “a perfect storm” caring for patients while also dealing with higher costs and unstable funding. “With all the challenges PrairieStar faces to maintain access to care for the uninsured and the underinsured, having someone imply that we don’t fulfill our mission is certainly rubbing salt in the wounds,” he wrote in an email.

Anderson said PrairieStar generally tries six times to communicate with patients before sending them to collections. He also said every patient is given the option to apply for sliding-scale discounts based on income and about a third choose not to provide that information.

Other health center leaders also explained their decision to pursue patient debt through lawsuits, in response to questions from ProPublica. “We understand that sending accounts to collections can seem at odds with that mission, and it’s not a decision we take lightly,” said Renee Hively, the CEO of CareArc, a community health center in Kansas. CareArc has appeared in local news for pursuing one patient’s medical bill through a lawsuit and wage garnishments for more than 12 years, contributing to her being unable to afford basic utilities. (CareArc did not respond to a request for comment about that particular case.)

A spokesperson for the department that oversees community health centers in Monterey County, California, told ProPublica that most unpaid bills it sends to collections “involve small amounts that do not justify the cost of initiating legal proceedings.” As a result, none of........

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