A perfect storm looms for federally qualified health centers whenever the federal government decides the COVID-19 public health emergency is over.
When that declaration ends, which isn’t expected to happen until at least October, many community health center patients are expected to lose Medicaid coverage, leaving the clinics without reimbursement for the services they provide. Planning for the future is further complicated by a looming funding cliff in fiscal year 2023 and numerous other political challenges.
“It’s very stressful looking for money instead of caring for people,” said Mary Elizabeth Marr, CEO of community health center chain Thrive Alabama. “We are the ones taking care of people no one else wants to take care of, and yet we have to do all kinds of heroic things to try to raise funds.”
The financial uncertainty comes amid rising operating costs and a pandemic that is disproportionately harming low-income communities served by federally licensed health centers. Increased federal funding during the public health emergency is supporting COVID-19 testing and treatment services, and changes to telehealth and reimbursement regulations are improving access. But all of that could go away before the virus does.
“There are kinds of fires going in all directions,” said Amanda Pears Kelly, CEO of Advocates for Community Health, a coalition of large community health centers.
Medicaid Reviews
The health sector is planning and worrying about the eventual end of the public health emergency, during which states must maintain their Medicaid roles to receive additional federal funds.
But up to 16 million people could lose Medicaid coverage when the designation expires and states resume verifying enrollees’ eligibility. Medicaid is the primary payer for community health centers in most states, and the majority of centers have reported an increase of up to 25% in the number of Medicaid patients during the pandemic, according to the National Association of Community Health Centers. .
Federally licensed health centers must care for people regardless of their ability to pay. But patients losing their coverage could wreak havoc on those clinics’ finances.
HealthSource of Ohio, a Loveland-based community health center, estimates it will lose about $500 in reimbursement for each patient removed from Medicaid when re-determinations resume, said Becky McMullen, the provider’s director of success and enrollment. . If every patient newly enrolled in Medicaid last year lost coverage, the clinic would lose more than $1.25 million, she said.
Huntsville-based Thrive Alabama expects an influx of patients who no longer have insurance, which would negatively affect its bottom line, Marr said. That makes expanding Medicaid into states like Alabama that don’t have it even more urgent, she said.
“There is a desperate need,” Marr said. “We’re just not getting the funding we really need to care for the underinsured, uninsured and low-income people.”
Community health centers also play a crucial role in helping people obtain and retain health benefits. In 2020, federally licensed health centers conducted more than 3.6 million insurance assistance sessions, said Jeremy Crandall, director of state and federal policy at the National Association of Community Health Centers.
The Partnership Community Health Center in Appleton, Wis., is preparing for a massive campaign to help patients who need to renew their Medicaid coverage or purchase other insurance once new determinations begin again. The vendor is planning a public education campaign that will include flyers, postcards and social media ads. The center also plans to text patients about coverage options and include messaging about enrollment in post-visit summaries and billing statements, said Julia Garvey, who works as a policy advisor and navigator at the Partnership Community Health Center.
Community health centers can help states prepare for Medicaid renewals, Crandall said. But these vendors’ relationships with government agencies and planning for redeterminations vary widely.
For example, the Partnership Community Health Center participates in a task force on statewide Medicaid reviews, plans to use state-created educational materials, and has a productive relationship with the Department of Human Services. Wisconsin Health, Garvey said.
By contrast, HealthSource of Ohio has heard nothing of his home state’s redetermination plans, McMullen said. “If we had that information — the Ohio plan — we could incorporate their verbiage into our presentation to our consumers,” she said.
COVID-19[feminine] funding
Community health centers have also received increased grants to support COVID-19 testing and vaccinations, said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation. These clinics will continue to test and vaccinate patients, but additional funds may not be available in the future, she said. A federal fund to finance COVID-19 care for uninsured patients has already closed.
When COVID-19 funding runs out, clinics in Thrive Alabama will likely need to incorporate pandemic-related operations into their overall operating budget, Marr said. The organization has hired additional nurses and administrative staff to provide testing and comply with federally mandated data reporting in response to COVID-19. These will be needed in the long term, she said.
Community health centers are also working to resume services they have suspended due to COVID-19 and catch up on delayed care, especially childhood vaccinations. Other programs initiated using telehealth may be closed without adequate refunds or policy changes, center leaders mentioned. Medicaid telehealth policies vary by state, and the federal government extended many Medicare flexibilities for 151 days after the public health emergency ended.
“All of this requires resources. They probably need to maintain the increased funding they’ve gotten,” said Sara Rosenbaum, professor of health law and policy at George Washington University’s Milken Institute School of Public Health. . “Just because the federal government decides, for various reasons, that we are no longer in a technical emergency does not mean that these communities are not facing increased needs due to the pandemic.”
340B restrictions
The limits of the 340B drug discount program imposed by pharmaceutical companies also pose a threat to safety net clinics, Rosenbaum said. Drugmakers have limited rebates, saying the program has grown too big and isn’t serving patients well. But the federal government has informed manufacturers that their restrictions could result in fines.
“All of these things put together are like a tsunami of issues that are happening at a time when the virus is still very much present, especially in the poorer communities where the health centers are operating, and their costs are enormous,” Rosenbaum said. .
Federal funding cliff
In addition to the challenges for community health centers, their largest source of funding is set to expire in fiscal year 2023. The majority of federal grants for these providers come from the Community Health Center Fundthat Congress established in 2010 and repeatedly reauthorized.
Congress is likely to extend the funding again. But not knowing how many currency centers will be allocated for the next two years makes planning difficult, Pears Kelly said. “This kind of uncertainty is tragic and affects everything,” she said.
Community health advocates on Wednesday launched a campaign calling on Congress to allocate $30 billion to federally licensed health centers by 2030, starting with $13 billion in 2023. These clinics are expected to receive 5, $7 billion in mandatory and discretionary funding in fiscal year 2022.
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