Recent budget crisis has federally funded clinics asking – how much will health care reform help them?

The Hurtt Family Health Clinic in Tustin had a close call recently. The Federally Qualified Health Center feared the loss of a $667,000 federal grant expected in March. Instead of getting their federal Healthcare for the Homeless grant this spring, they got a notice telling them that the budget impasse in Washington D.C. had locked their funds, along with bit of money to cover operating costs through May.

The federal gridlock didn’t result in disaster for the clinic–- this time. Hurtt and all other Federally Qualified Health Center expecting continuation funding got their funding continued in early June, said the Health Resources and Services Administration’s Director of Communications, Martin Kramer.

But clinics may continue to struggle. The budget cuts resulted in the denial of millions of dollars in new grant requests and saw cuts of over $600 million to the Health Center Appropriations for 2011, said Kramer.

Hurtt and other Community Health Clinics across the state need every dollar they can get, and they are not optimistic that they will have sufficient funds to expand clinics to keep pace with increasing demand.

Their experiences lead them to doubt, too, that increased funds from the coming health care reform will be a balm for their budget troubles.

Responding to increased demands with decreased federal funds

East San Diego County-based Mountain Health operates fives clinics in the rural San Diego communities of Alpine, Escondido and Campo. Mountain Health was hoping for $220,000 under the new Expanded Medical Access grant. They were denied because of budget cuts, said CEO Judith Shaplin. They’d slated the money for everything from hiring additional physicians and case managers to getting a badly needed pharmacy at their Campo facility.

An increasing number of patients have filed into the clinics. The percent of uninsured patients coming to Mountain’s facilities, for instance, went from 20 percent in 2009-10 to 34 percent in 2010-11. The clinic, however, hasn’t seen the needed resources to support the increase.

Instead, Mountain Health has to hold off on planned expansions to ancillary services, and multitasking is a given for the staff. “This amounts to longer waiting times for patients, and our staff wearing multiple hats,” Shaplin said.

Their inability to hire more staff to cope with increasing numbers of uninsured patients base is a daily challenge, Shaplin said.

Like Mountain Health, Hurtt also treats patients regardless of their ability to pay, which is why it largely depends on federal assistance to sustain it. Federal funding, including the Healthcare for the Homeless grant, is one of Hurtt’s vital sources of support.

As director, Amavizca said it is part of her job to continually be on the lookout for other sources of funding. She has tried to be proactive, including a major restructuring of the clinic in 2004. That’s when Hurtt, which until then was operating as the Casa de Salud clinic in Santa Ana, was taken over by the Orange County Rescue Mission where Amavizca is Director of Health Care Clinics & Services.

Together with Amavizca and her staff, OCRM gave Hurtt a strategic makeover, repositioning the clinic to provide for a high volume patient base with minimal resources. OCRM moved the clinic three miles from Santa Ana to Tustin, where it is housed along with the Hurtt Mobile Clinic.

Both administer a full range of primary health care services (including dental) to the community’s homeless, poverty-stricken and uninsured population. Cities covered by Hurtt Mobile clinic include Tustin, Santa Ana, Orange and Garden Grove.

The most significant measure taken in Hurtt’s redesign, however, was obtaining status as a Federally Qualified Health Center. With federal grants as well as support from other donors since the takeover, patient services were expanded to a level that now accommodates a 140 percent patient volume increase since 2004.

“This is the hard part…you get a grant like this, which allows us to provide more all around, and now with more than double the patients, we’re left without it?” Amavizca said.

Will health care reform help?

The Affordable Care Act could provide clinics with a more stable line of funding. However, Shaplin describes herself as “cautiously optimistic” at best about the benefits of health care reform.

The ACA provides increased access to healthcare for patients who are currently uninsured, Shaplin said. But these reforms are very costly, and there are many gray areas in the law about how people qualify, and whether the new structure of the insurance market will be one that can support provider payment, she added.

Simply put, the biggest flaw is that the legislation doesn’t outline the exact mechanism for moving the ever-growing patient population into the program. California is trying to address this problem with their Bridge to Reform program, which will allow patients eligible for insurance under health care reform to begin receiving benefits before the Affordable Care Act begins.

One of Shaplin’s counterparts, Stephen Schilling, CEO of the Central Valley-based Clinica Sierra Vista, doesn’t believe it’s realistic to look toward the act as a source of increased funding. Sierra Vista recently agreed to participate in California’s Bridge to Reform program.

Schilling’s assessment is based on the dismal state of the economy and resulting budget cuts in Washington. Considering the cuts made to the regular budget, provisions under the Affordable Care Act don’t amount to “increased” funds, Schilling said. If anything, they just serve to compensate for the funding that clinics have recently lost.

Sierra Vista is comprised of 16 ambulatory facilities and a mobile health provider, and serves homeless and indigent patient populations across Inyo, Kern and Fresno counties. Increased funds from health care reform will only serve to keep community health centers funded at the same level as other sources of federal money are slashed, Schilling said.

The biggest problem, Schilling said, is that there is nothing being added to the existing budget to facilitate the clinic expansions that there will be a desperate need for after health care reform begins.

“This doesn’t yield the advantages we were hoping for…to get community clinics prepared for the new wave of insured patients under the PPACA with additional health centers,” Schilling said.

The bottom line amounts to continued uncertainty for clinics, directors said. Amavizca, Melgar, Shaplin and Schilling all agreed that there are a number of blind curves on the road ahead. They will operate, they said, with the knowledge that planning ahead is just not an option until there is more economic stability.

“We’re bracing for a lot of different scenarios,” Schilling said.

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