Clinics facing lapse in funding

Tough decisions ahead for facilities helping the uninsured if coronavirus and demand surge again

Nobody wants to see another COVID- 19 wave, but for health clinics serving low- income Coloradans, an increase in demand for testing and treatment at this point could be a financial disaster, as well as a humanitarian one.

Federal funding to cover COVID- 19 testing and treatment for uninsured people ended late last month, and reimbursements for the staff time to vaccinate people against the virus will halt Tuesday.

If demand remains relatively low, it’s going to be significantly easier to find enough money to cover services for people without health coverage, said Ben Wiederholt, president and CEO of STRIDE Community Health Center.

About one- quarter of the patients at STRIDE’S Denver- area clinics are uninsured, and it’s not an option to charge them the full cost of care or to stop serving them, he said.

“We’re still trying to quantify the impact” of losing federal reimbursement, he said. “It really took us off guard.”

The White House also announced it was slashing shipments of treatments to states to stretch the available supply, because it was out of money to buy more, and that it wouldn’t be able to purchase enough shots to offer everyone a fourth vaccine dose at some point. So far, the Centers for Disease Control and Prevention has authorized fourth doses only for people who are over 50 or have compromised immune systems.

Funding for those portions of the federal COVID- 19 response was stripped out of a bill after Republicans balked at the additional spending and Democrats objected to taking the money from other pandemic response funds.

A proposal in the Senate would allocate $ 10 billion to buy vaccines and treatments, which is about half of what the Biden administration requested. It’s not clear, however, if it has the votes to pass.

People with insurance coverage should still be able to access treatment, but they may have to pay at least some of the cost of the drugs, depending on how much out- of

pocket spending their plan requires, according to an analysis by the Kaiser Family Foundation.

Some labs have announced that people without coverage may have to pay $ 100 or more out of pocket for the most sensitive type of COVID- 19 test. That’s not an option for community health centers, which have to balance keeping their doors open with offering affordable care, Wiederholt said.

Patients with very low incomes sometimes pay as little as $ 12 for testing, which won’t cover the cost of processing it, he said.

“We don’t want to raise that price to a point where it becomes unaffordable,” he said.

If uninsured people don’t get tested, they may not know they need to isolate, and they won’t be eligible for treatments that can reduce the risk of hospitalization or death, Wiederholt said. Antiviral pills significantly can reduce the odds that higher- risk people will end up in the hospital, but patients have to start taking them within five days of developing symptoms — meaning a person who delays testing because of worries about the cost may end up outside that window.

While Colorado paid for enough doses to vaccinate children younger than 5 and some adults, clinics won’t be reimbursed for the staff time used to provide them to uninsured people after Tuesday.

Providers who offer the COVID- 19 vaccine are required to give it at no cost to the recipient, even if the patient is uninsured, said Brian Spencer, spokesman for the Colorado Department of Public Health and Environment. But without the federal reimbursement, providers will have to absorb the cost of labor and supplies for administering the shots, and some may decide that it’s not worth providing the vaccine anymore, he said.

On Wednesday, the state health department reported it had about 470,000 adult- sized doses of the vaccine, but up to 1 million people could be eligible for a fourth shot.

The state received about 35% fewer doses of monoclonal antibodies to treat COVID- 19 last week than it had in recent weeks, Spencer said. So far, that’s not a problem, he said. Monoclonal antibodies significantly can reduce the odds of hospitalization for people who are at high risk because of their age or other health conditions.

“Because COVID- 19 cases are so low, orders for these medications have dropped off significantly, and we have been able to accommodate all orders from providers with the allotments we have received,” he said.

On Thursday, Gov. Jared Polis released a statement asking Congress to fund the uninsured reimbursement program and to appropriate enough money to purchase more COVID- 19 treatments and additional booster doses for all Americans.

“As a state, we can take action on many of the challenges we face, but we cannot solve all the existing challenges without federal action and support,” Polis said in a news release. “Any loss of life is tragic, and we are all suffering from the loved ones who are no longer with us due to this brutal pandemic. But losing lives at this juncture when COVID- 19 is now preventable through our effective and safe vaccines and is treatable with the many therapeutics is unthinkable.”

Polly Anderson, vice president of strategy and finance for the Colorado Community Health Network, estimated about 22% of the average center’s patients are uninsured, although it varies quite a bit across the state. Each center will face different challenges, depending on how many patients are uninsured and how great the demand for testing is, but it’s likely many will have to put off hiring people or raising wages — a problem, because they can’t compete with hospitals, she said.

“It’s not an option for us to pass on the cost of a vaccine,” she said. “We’re all hoping we don’t get another wave, but it doesn’t look like it.”

Colorado is one of 15 states that allows Medicaid to pay for testing, treating and vaccinating uninsured people, but that coverage will end when the public health emergency does, according to the Kaiser Family Foundation’s analysis. The timing will be difficult, because people who are “locked in” to Medicaid during the emergency will lose coverage in the months after it ends, Anderson said.

“We’re going to expect the uninsured ( rate) to rise just as that special funding is going to run out,” she said.

The STRIDE clinics might be able to repurpose some funding they received under the American Rescue Plan Act to cover the costs of treating uninsured people, but that could require permission from the Health Resources and Services Administration, which approved clinics’ plans to use the stimulus money, Wiederholt said.

“We did not anticipate when we created this budget last year that this uninsured program would be discontinued,” he said.