Spe­cial re­port: Work­place clin­ics grow in num­ber, so­phis­ti­ca­tion

Com­mu­nity health cen­ters work to block cuts

Modern Healthcare - - Front Page -

Af­ter tak­ing a fund­ing hit in the lat­est round of fed­eral bud­get skir­mishes for fis­cal 2011, of­fi­cials for com­mu­nity health cen­ters are gear­ing up to try to pre­vent fu­ture po­ten­tial cuts to their fed­eral and state rev­enue.

Com­mu­nity health cen­ters, also known by their gov­ern­ment des­ig­na­tion of fed­er­ally qual­i­fied health cen­ters, are fac­ing po­ten­tial fund­ing losses as a re­sult of cuts to di­rect fed­eral grants and re­duced Med­i­caid rev­enue.

Health cen­ters for the bal­ance of fis­cal 2011 end­ing Sept. 30 al­ready are fac­ing a shift in their fed­eral dol­lar al­lot­ment as a re­sult of the April bud­get agree­ment. While the cen­ters aren’t re­ceiv­ing less money than they did in fis­cal 2010, rep­re­sen­ta­tives of the in­dus­try view it as a cut be­cause a health­care re­form-re­lated ex­pan­sion may now be threat­ened as a re­sult of the con­gres­sional ma­neu­ver­ing.

A re­form-linked statu­tory pay­ment of $1 bil­lion into a trust fund to­ward the ex­pan­sion of com­mu­nity health cen­ters now ap­pears more likely to be used to mostly cover a drop in Congress’ reg­u­lar grant al­lo­ca­tion for the cen­ters. The bud­get agree­ment for fis­cal 2011 in­cluded a $660 mil­lion cut to health cen­ter pri­mary-care fund­ing, which fell to $1.5 bil­lion from $2.1 bil­lion in fis­cal 2010. The gen­eral idea be­hind the cut is that the $1 bil­lion trust fund money un­der the Pa­tient Pro­tec­tion and Affordable Care Act can cover the lost funds while still pro­vid­ing ex­tra money to health cen­ters.

Now, ad­vo­cates for com­mu­nity health cen­ters are work­ing to pre­vent more cut­ting. “They are ex­ceed­ingly de­ter­mined not to lose any more money,” says Sara Rosen­baum, law pro­fes­sor at the Ge­orge Wash­ing­ton Univer­sity School of Pub­lic Health and Health Ser­vices, Wash­ing­ton.

An Au­gust re­port Rosen­baum coau­thored from the Kaiser Com­mis­sion on Med­i­caid and the Unin­sured notes that most of the trust fund ex­pan­sion money—$9.5 bil­lion out of $11 bil­lion to­tal over five years—was ex­pected to add new health cen­ter grantees and ser­vices

“They are ex­ceed­ingly de­ter­mined not to lose any more money.” —Sara Rosen­baum, law pro­fes­sor, Ge­orge Wash­ing­ton Univer­sity

sites, and en­hance ser­vice ca­pac­ity of new and ex­ist­ing sites. The bal­ance was to go to­ward cap­i­tal needs for ren­o­va­tion and in­for­ma­tion tech­nol­ogy, in prepa­ra­tion for the added pa­tients com­ing through re­form ex­pan­sions, ac­cord­ing to the Kaiser re­port. Rosen­baum es­ti­mates 5 mil­lion pa­tients who could have been served at the clin­ics un­der the ACA will not be as a re­sult of the fund­ing changes.

“They cut the dis­cre­tionary pro­gram and ar­gued that it wasn’t a cut be­cause the trust fund was there,” says Jose Ca­ma­cho, ex­ec­u­tive di­rec­tor and gen­eral coun­sel for the Texas As­so­ci­a­tion of Com­mu­nity Health Cen­ters, Austin. That cre­ates a prob­lem, he says, be­cause the trust fund money is for only five years, while the ex­pan­sion of the health cen­ters is ex­pected to help meet the in­creased de­mand when the ma­jor el­e­ments of health­care re­form kick in Jan. 1, 2014.

“If you con­tinue to cut that dis­cre­tionary fund­ing pro­gram, what hap­pens? No. 1, you can’t build the ca­pac­ity to serve ex­tra peo­ple,” Ca­ma­cho says. “No. 2, when the trust fund goes away,” you’ve crip­pled the com­mu­nity health cen­ter pro­gram.

Com­mu­nity health cen­ters were backed by for­mer Pres­i­dent Ge­orge W. Bush and are con­sid­ered a ma­jor com­po­nent of the Affordable Care Act. Dur­ing Bush’s first term, HHS’ Health Re­sources and Ser­vices Ad­min­is­tra­tion launched the Pres­i­dent’s Health Cen­ter Ini­tia­tive in 2002, which achieved its goal of es­tab­lish­ing new or ex­panded health-cen­ter sites in 1,200 com­mu­ni­ties. Fund­ing also grew sig­nif­i­cantly un­der Bush to its roughly $2 bil­lion fund­ing lev­els, but the lat­est move by Congress is a step back­ward, in­dus­try of­fi­cials say.

Daniel Hawkins, se­nior vice pres­i­dent with the Na­tional As­so­ci­a­tion of Com­mu­nity Health Cen­ters, Bethesda, Md., says the roughly 800 ap­pli­ca­tions filed by com­mu­nity health cen­ters for ex­pan­sion won’t be funded, putting the ex­pan­sion on ice, and it’s an open ques­tion as to what will hap­pen in the next fis­cal year.

To raise aware­ness of the sit­u­a­tion among con­gres­sional lead­ers, the NACHC led an ef­fort to garner sig­na­tures for a letter of sup­port for com­mu­nity health cen­ters. The letter re­ceived sig­na­tures of 110 House mem­bers from both par­ties and was sent to two key mem­bers of the House Ap­pro­pri­a­tions Com­mit­tee, Rep. Denny Re­hberg (R-Mont.), chair­man of the sub­com­mit­tee on La­bor, HHS, Ed­u­ca­tion and Re­lated Agen­cies, and Rep. Rosa DeLauro (D-Conn.), the panel’s rank­ing mem­ber.

Donna Thompson, CEO of the Ac­cess Com­mu­nity Health Net­work, Chicago, which op­er­ates 58 health fa­cil­i­ties in the metropoli­tan area, says her net­work had ap­plied for ex­pan­sion funds and has not given up hope on re­ceiv­ing some. “We’re hop­ing that in the new fis­cal year

Rod Man­i­fold, cen­ter, ex­ec­u­tive di­rec­tor of Cen­tral Vir­ginia Health Ser­vices, ad­dresses a March brief­ing in Wash­ing­ton for con­gres­sional staff tout­ing the cost­ef­fec­tive­ness of com­mu­nity health cen­ters.

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