Dear members of the Board,

We are patients, parents, clinicians, educators, and neighbors from across Humboldt and Del Norte counties. We are writing to you directly, as the body that governs Open Door, about the decision to stop starting patients under 19 on gender-affirming medication.

Many of us have trusted Open Door with our own care and our children's care for years. You volunteered to govern a community clinic, and we believe, as we expect you do, that a community clinic answers to the community it serves. Decisions about which services Open Door provides belong to this board. That is why we are bringing this to you. Above all, we are asking for one hour: time for the board to hear directly from the families this decision affects.

What changed for these families

Until this summer, a young person starting this care at Open Door saw a clinician who knew them. Their labs were drawn in the same building, they could ask for help learning to do their own injections, and all of it was coordinated with the rest of their primary care.

Now, families are handed a flyer with two phone numbers. One of those providers does not see anyone under 16, and requires parental consent and a therapist's letter for 16- and 17-year-olds. The other is virtual-only and lists self-pay charges. For someone in Willow Creek this can mean telehealth appointments, lab work they have to arrange on their own, insurance challenges, and giving injections alone at home.

These young patients have been given an obstacle course instead of a helping hand. Some will get through it. Some will not, and we think that the board should carefully reconsider the effects of its decision on our community.

What the federal picture actually is

We do not dismiss the pressure the federal government is putting on community health centers. It is real, and it is designed to intimidate. You may have heard that a new CMS rule takes effect October 13. Open Door stopped starting new patients in July, before that rule was even final, and the rule does not require what Open Door did. It limits federal Medicaid payment. It does not prohibit a clinic from providing care. It allows states to pay with their own funds, and it gives patients already on hormones a six-month transition. California has announced that, starting October 13, it will pay for this care for Medi-Cal patients with state funds, and California's Attorney General has joined a multistate lawsuit to block the rule.

Open Door has never named the law, rule, or grant condition it believes requires this cutoff. It also never explained why the cutoff reaches 18-year-olds, who are adults under California law.

We are not asking you to break any rule. We are asking you to use the room you have.

What we ask the board to do

1. Give us one hour. Before anything else, we ask that the board hold a community listening session, with confidential options for families who can't speak publicly, and hear directly how this decision has affected them.
2. Make a plan to restore access. Tell the community the legal basis for this decision, when the board will review it, and what change in law, regulation, or funding would restore care.
3. Keep this care at Open Door. If federal funding is the obstacle, work with the state, local philanthropy, and community partners to fund this care separately, in Open Door's own clinics. We are ready to help.
4. Put the promise to current patients in writing. Open Door has said current patients' care will continue without interruption. We ask the board to make that a written policy, so no established patient goes without medication, labs, or follow-up because of this change.

This will not stop with these patients. Whatever Open Door builds to protect them now will protect the next patients who are singled out.

On Friday, September 25, many of us gathered at the Humboldt Labor Temple in Eureka to talk about this decision and argue for a reconsideration. We would like the board to hear from us directly. Give us that hour.

We ask for a written response from the board, as a body.

Respectfully,
The undersigned