The Riverside Press-Enterprise
As Medicaid shrinks, clinics for poor trying to survive
TYLER, Texas — Appointment cancellations and financial distress have become a constant at Bethesda Pediatrics, a nonprofit medical clinic in East Texas that is heavily dependent on Medicaid, the health insurance program for the poor.
On a recent Monday, the mother of a toddler who had a primary care appointment broke down in tears after learning the child had just lost Medicaid coverage, wondering how she could pay the bill.
Another mother told Dr. Danny Price, the clinic’s lead pediatrician, that she was afraid to get her child a flu shot because of the $8 fee she would have to pay now that the child had been dropped from Medicaid.
A child with depression did not show up — most likely, Price presumed, because of having lost Medicaid coverage.
The uncertainty and panic at the clinic, tucked inconspicuously in a poor residential pocket of Tyler, Texas, highlight a little-examined consequence of the vast trimming of the Medicaid rolls since a policy that banned states from kicking anyone out of the program during the pandemic ended last spring. The loss of coverage has not only affected families but is also threatening the financial stability of vital components of the American safety net.
Medicaid payments are “the lifeblood of our health centers and their ability to serve,” said Dr. Kyu Rhee, the president and CEO of the National Association of Community Health Centers, which treat roughly 1 in 11 people in the United States and rely on Medicaid
and federal grants to provide a financial cushion for the uncompensated care they give uninsured patients.
Since last spring, Medicaid enrollment has dropped by almost 10 million, including around 4 million children, according to researchers at Georgetown University. States have removed people for a variety of reasons, including for changes in income and age. Some people have been dropped because they did not return paperwork. Others have lost coverage because of technical errors, including computer glitches.
The loss of reimbursements for millions of patients has contributed to an already difficult financial picture for facilities that treat the poor: Unless Congress reaches a funding agreement, nearly $6 billion for federally financed health clinics, which serve more than 30 million people, most of them low-income, could lapse in early March.
Those health centers have each seen revenue losses of at least $500,000 because of the Medicaid unwinding, according to Amy Simmons Farber, a spokesperson for the health center association.
By the end of December, Family Health Centers, a
network of clinics in Louisville, Kentucky, had lost more than 2,000 Medicaid patients since the policy change took effect in April, an almost 6% decline, said Melissa Mather, a spokesperson for the clinic. For every percent decline in Medicaid patient visits, she said, the clinic experiences a revenue decline of $175,000 to $200,000.
Bethesda is now engaged in a “month-to-month game of survival,” said Amber Greene, Bethesda’s operations manager, who also works as a nurse.
Standing in a supply closet to make her point, she gestured to a modest stash of Tylenol, Motrin and thermometers, which the church next door had donated. The clinic, with the vast majority of its patients on Medicaid, needs roughly $115,000 each month to operate its medical and dental clinics but still runs a monthly deficit of around $10,000.
Sometimes the costs it eats are small, such as the fee for the shot Price administered to the mother who could not pay. But they add up, forcing the clinic to get creative to preserve funds. A local pharmacy offers substantially discounted antibiotics, and the clinic cut the costs of its virus tests by conducting them in-house.