On Monday, lawmakers were told that rising uninsured rates, mounting unpaid care, delayed government payments and a partially funded dental expansion are tightening pressure on Frederiksted Healthcare Inc.
Frederiksted Healthcare is a nonprofit community health center and federally qualified health center on St. Croix serving low-income and medically underserved residents. Chief Executive Officer Masserae Sprauve Webster testified before the Senate Budget, Appropriations and Finance Committee and said the center now treats more than 9,000 patients each year, roughly one in four residents of the island.
The center operates three sites on St. Croix and provides primary care, women’s health, dental care, mental health treatment and case management. It also offers extended evening and weekend hours to improve access and reduce reliance on emergency rooms for nonemergency care. Webster said they are seeing more patients experiencing homelessness and serious mental illness. She described a growing number of people with serious psychiatric conditions visible on the streets.
Frederiksted Healthcare Inc. is requesting about $3.59 million in annual government funding to support operations, staffing, and utilities, and to help cover the local match required for federal Medicaid dollars.
A key concern was the rising share of patients without insurance. Webster said the rate has doubled in recent years, climbing from 14% in 2022 to 28% in 2025. Because the center treats patients regardless of ability to pay, she said, that shift has driven a steep increase in services delivered but never reimbursed.
She estimated that uncompensated care reached about $9 million last year and is expected to rise toward $10 million over the next two budget years. The center bills patients and offers sliding‑scale fees, but does not turn unpaid accounts over to collections. Instead, it periodically writes off long‑overdue balances.
At the same time, Chief Financial Officer Jacqueline Rhymer George said monthly government payments have lagged, with no allotments received since February. To stay operational, she said, the center has relied on its regular billing revenue and about $6 million in reserves held in short‑term U.S. Treasury investments to cover payroll and pay vendors during the gap.
Dental care emerged as one of the most pressing needs. Webster said Frederiksted Healthcare Inc. is currently the only public dental provider on St. Croix and has held that role for roughly 14 years. The center operates 11 dental operatories and is planning an expansion in Sion Farm that would add five more treatment rooms.
That project is not yet fully funded. Webster said the center is requesting a one‑time $300,000 territorial appropriation to complete construction, in addition to federal grant funding and internal funds the organization has already committed. Several senators signaled support for the request and characterized the dental expansion as a cost‑effective way to improve access to care.
Lawmakers also questioned the status of the territory’s Health Information Exchange, a digital system intended to allow hospitals and clinics to securely share patient records. Webster said Frederiksted Healthcare Inc. and at least one other community clinic are connected to the system, but major hospitals are not fully integrated. She said the gap leads to duplicated testing, medication risks and fragmented care, and warned the Virgin Islands is falling behind other jurisdictions in building modern health data systems.
In terms of workforce shortages, Webster told lawmakers the organization has adopted a “grow your own” approach, supporting employees as they advance into clinical roles. She noted that the center operates the territory’s only accredited dental residency program and said the ‘grow your own’ model has helped increase dental staffing and expand access to preventive services on St. Croix.
Webster said broader coordination across the territory’s health system has weakened since the height of the COVID‑19 pandemic. During the public health emergency, she noted, the Health Department, hospitals and community health centers met frequently to share information and plan responses. “When we were undergoing COVID, we had regular meetings, but since we’ve gotten through that … we haven’t had discussions as frequently as I think we should,” she told senators, adding that it should involve “all the health care facilities coming together to have more regular type discussions” to address ongoing gaps in medical, dental and behavioral health services.
Overall, senators expressed strong support for Frederiksted Healthcare Inc.’s work and budget request. Sen. Dwayne M. DeGraff said, “I support you one hundred percent. We’re going to get you what you need because you’re consistently doing great work.”
Sen. Kurt A. Vialet pointed to the center’s efficiency compared with its level of public funding, saying lawmakers were getting “bang for the buck” and that it was “monies that are well spent.”
Webster told lawmakers that even with three sites and extended hours, Frederiksted Healthcare Inc. struggles to meet all the demand for routine care on St. Croix. She estimated that about 15,000 residents do not have a regular primary medical provider, which can lead to longer wait times and more advanced illness when patients are finally seen.
The hearing underscored Frederiksted Healthcare Inc.’s central role in St. Croix’s health system as a major provider of primary and specialty care and a key safety net for uninsured and low-income residents. While lawmakers expressed broad support for its funding requests and praised its financial management, the testimony highlighted broader pressures, including rising uninsured rates, fragmented health data systems, workforce challenges and gaps in services that continue to strain the territory’s health care system as budget decisions move forward.
