Howard Brown Health laid off 43 employees Monday. It's the latest action the health care provider has taken to offset a $6.6 million budget shortfall.Five of the positions directly treat patients and eight work with, but don't treat, patients. The rest were management or back office positions, according to a statement from Howard Brown. The provider said the layoffs will not disrupt patient services.Howard Brown lost $3.5 million in grant funding for this year's budget, which supported many of the laid-off positions. That lost funding included $1.6 million from the American Rescue Plan, funding supplied by the federal government to help recover from the COVID-19 pandemic, according to a statement. The health care provider, which cares for low-income, LGBTQ+ and HIV-positive patients, is also expecting a loss in funds from federal drug reimbursements."This is the third year in a row we have run an operating budget shortfall," Robin Gay, interim CEO of Howard Brown, said in a letter sent to employees. "We cannot continue to do that if we want to sustain our organization and continue to serve the patients who rely on us for the long term."The provider closed two clinics in May, also citing financial woes. A Howard Brown spokesperson said Monday the layoffs were not connected to the shuttered clinics.The laid-off employees, making up 7% of Howard Brown's workforce, were given 60 days' notice. Their last day will be Aug. 30, at which point they'll receive severance and most will continue to have health insurance till the end of September, a spokesperson said.Twenty-nine of the terminated positions were union, and 14 were non-union, according to Howard Brown.But a spokesperson with the Illinois Nurses Association, which represents unionized workers at Howard Brown, said 30 unionized employees were laid off, but they said Howard Brown disputed the additional employee's union status. The association also said in a statement impacted employees were shut out of all systems Monday morning without notice and could not complete patient visits."Howard Brown waited until the day after Pride month ended to announce this new round of layoffs," the union said in an emailed statement. "Multiple people that [Howard Brown Health] is laying off walked with Howard Brown in the pride parade this past weekend without knowing management’s plan."A Howard Brown spokesperson said it was a standard procedure to remove a laid-off employee's access after they received notice. But any employee that decides to continue working within the 60-day notice period will have their access restored. John Matz, an aging services case manager at Howard Brown, said in the union's statement he was laid off after working at Howard Brown for four years. He said he was one of the employees who lost access to the provider's systems.“My job is to help people going through housing and safety crises, and I have no way of contacting my patients to assist or connect them with other case managers," Matz said. "A patient in crisis who needs access to housing had an appointment with me today, but their crisis will continue to escalate due to [Howard Brown Health] cutting off my access before the official layoff date."Despite the layoffs, Gay said in her letter Howard Brown plans to expand services and hours at their South and West side locations and hire a medical director for their trans and gender-diverse patient services and more infectious disease specialists.In December 2022, Howard Brown, citing a $12 million budget shortfall, laid off 61 employees. The layoffs triggered two employee strikes in January and November 2023.The National Labor Relations Board filed a complaint against Howard Brown earlier this year for bargaining in bad faith with the union. The company later reinstated 24 of the laid-off employees and more than 30 others were ordered to receive back pay.In May, Howard Brown’s union employees ratified their first contract after more than 17 months of negotiations.