The program that connects Island residents with affordable health insurance has been forced to cut its staff and operations, as of the start of this year. Facing a shortfall of $80,000, Vineyard Health Care Access program director Sarah Kuh this week appealed to add an article to all town warrants asking taxpayers to make up for losses from shrinking grants.

“We have lost employees and we’re more restricted in the services we can provide,” Ms. Kuh told a panel of town leaders at a meeting of the All-Island Selectmen Wednesday night.

The position of enrollment specialist, which came with benefits and a $32,000 annual salary, has been cut. In addition, Ms. Kuh cut back the hours of a health access specialist and a bilingual community health outreach educator.

The program also scaled back its own hours. It is now open from 8 a.m. to 4 p.m. instead of 8 am. to 5 p.m.

The reduction in services comes just as many Island residents have a greater need for the program. “When the economic situation is poor, health and human services are even more in demand,” Ms. Kuh said in an interview. “When people are losing their jobs and their insurance, this is where they come.”

The program typically books between 15 and 20 appointments daily, and she expects to stay solidly booked.

Yet Vineyard Heath Care Access is, she said, “pretty vulnerable right now to fluctuations in funding. I’m not quite ready yet to say that anything is imminent in terms of us going away . . . We may come out in the next six months and look pretty good and we may not. We just don’t know. There is a lot of uncertainty.”

The budget shortfall stems from an accumulated loss in grant money. Two thirds of the program’s $270,000 budget comes from state and national grants. “Historically, we’ve been phenomenally successful getting the grants we’ve applied for,” Ms. Kuh said. “But . . . none of them is guaranteed.” She is still waiting to hear back on a number of grant applications. She will know the result of one by Feb. 1 and the rest in the spring.

Vineyard Health Care Access first opened in 1999 after a survey showed Vineyard residents were twice as likely as those on the mainland to be without health insurance; at half-time, Ms. Kuh was the only employee. Over the years, the program grew, as did the number of Island residents with insurance. In 2008, the program employed five people and met with roughly 1,500 clients. As a direct result of those visits, Ms. Kuh said, about 2,500 Island residents have health insurance.

Historically, one third of the budget came from the Dukes County Commission, but, facing its own economic woes in late 2007, the commission voted to decrease its funding to the program and now the towns also contribute funding.

Last year, Island residents showed overwhelming support for the program when they voted to dip into their own tax dollars to help sustain it. At town meetings in every Island town, voters agreed to a plan in which the county’s share of funding would incrementally decrease while the towns’ shares would incrementally increase over the course of five years. Eventually, the plan calls for the towns to fully fund the portion of the budget once covered by the county.

Last year, the towns kicked in $54,000. This spring, Ms. Kuh must go back to the towns and ask for this year’s allocation, a 60-40 split between the towns and the county for the non-grant third of the program’s budget. And now, because of the loss in grant money, she is asking the six towns to contribute a combined $52,000.

“We’re continuing with the plan developed with selectmen for shared responsibility of the costs, with a gradual increase,” Ms. Kuh told the meeting Wednesday. “Plus there is a request for an additional $52,000.”

Oak Bluffs selectman Ron DiOrio questioned the rationale behind two articles. “Why are these separate warrant articles? Why not agree to take a bigger chunk?” he asked.

“We did not want to appear to be tinkering with the formula,” Ms. Kuh replied.

“We don’t want you to be in the position where four towns approve it and two don’t. It’s a great program and it provides a great services to many Islanders,” pressed Mr. DiOrio. “That’s not a good idea,” countered Edgartown selectman Arthur Smadbeck. “You don’t want to put them together and open up the possibility of losing the whole thing. Sarah has shown responsibility in separating the articles. We don’t even know yet what the impact [of the recession] is. We’re not making up the difference on peoples’ budgets for grants not coming in.”

“I think our Island’s health care is a model for the nation,” said Jeffrey (Skipper) Manter. “But people are used to seeing this item, and it should stay on its own . . . then, separately, there’s the grant supplement replacement that will hopefully be there for just one year.”

But there is no guarantee that with that the combined taxpayer funding — totaling $140,000 — would see the agency through the coming year, Ms. Kuh said after the meeting.

“I wouldn’t say $140,000 doesn’t cover us exactly,” she said, explaining that she settled on the figure as a happy medium “considering the strain it puts on towns asking for money at all in light of the financial climate.”

As to the importance of securing the funding in both articles, she said:

“From where I’m sitting now, it’s vital.”