The Mendocino Beacon

Reimbursem­ent lagging to clinics that provided mpox vaccines

- By Kristen Hwang

Seven months ago, California battled its second widespread infectious disease outbreak in as many years — mpox, formerly referred to as monkeypox. Cases spread exponentia­lly, primarily among the state's male LGBTQ population, and officials struggled to roll out limited vaccine supplies from the federal government.

Community clinics and LGBTQ health centers opened mass mpox vaccinatio­n sites as quickly as possible and clamored for assistance from local and legislativ­e leaders, but oftentimes red tape at both the federal and state level hampered a speedy response.

Today, as the federal government ends its mpox state of emergency, those clinics say bureaucrac­y is once again standing in the way. State and federal reimbursem­ent for services — potentiall­y in the millions of dollars — has not been approved and likely won't be for months.

“I'm not clear what the holdup is,” said Craig Pulsipher, former associate director of government affairs at APLA Health, a clinic in Los Angeles specializi­ng in LGBTQ population­s. APLA Health administer­ed more than 4,000 vaccines and was one of the largest vaccinator­s in the city. It received an $83,000 grant for mpox work from the state Office of AIDS, but dedicated “hundreds of thousands of dollars” to vaccinatio­n and shifted funding from other programs to the response effort.

The Legislatur­e released $41 million in emergency funding for mpox response efforts last year, half of which has stayed with the state Department of Public Health. Approximat­ely $1.4 million went directly to community organizati­ons helping directly with vaccine efforts, but organizati­ons say it's not nearly enough to cover their costs.

Although the vaccine itself was given to states free-of-charge from the federal stockpile, community organizati­ons dispensing the shots still had to invest staff time, equipment and other resources to respond. Typically, shots and other minor procedures are billed as part of a “provider visit,” but that requires being seen by a doctor, which doesn't happen during the kind of mass vaccine drives that became commonplac­e for COVID-19 and mpox.

Instead, the state must petition the federal government to use Medi-Cal dollars for standalone vaccine reimbursem­ent to try to recoup some of the labor expenses. Medi-Cal is the state's insurance program for low-income people, and it's funded through state and federal dollars.

“This was everything we did for probably three months,” said Dr. Ward Carpenter, chief health officer with the Los Angeles LGBT Center. “We were barely able to keep our urgent care visits open for non-mpox related things…. It was at least as busy as the early days of COVID if not more so.”

The LGBT Center doled out more than 6,500 vaccines, Carpenter said, and has more than $500,000 in outstandin­g expenses. It received an $116,000 mpox grant from the AIDS office in November.

In September, California's Department of Health Care Services submitted a federal request for reimbursem­ent. Shortly after, members of California's Congressio­nal delegation, led by Democratic Rep. Jimmy Gomez of Los Angeles, sent a letter to the U.S. Health and Human Services branch urging timely approval of the request. Community clinics, which often serve as safety nets for poor and underrepre­sented patients, have little financial wiggle room and already had to wait two years for COVID-19 payment.

“Your rapid and urgent attention to these requests will help to ensure that critical providers and community clinics in our districts are able to continue their vital work,” the letter read.

Pulsipher said in November,

Gomez's office asked APLA Health if additional pressure on federal partners would be helpful, but the organizati­on turned him down at the time because state officials were confident the approval was coming soon.

“What we heard from (the state Department of Health Care Services) was they were moving forward and that pressure wouldn't be needed,” Pulsipher said. “It has yet to be approved.”

The department told CalMatters in a statement that the federal government must approve California's plan to use MediCal dollars for mpox reimbursem­ent. The federal government sent the state comments and revisions to the plan in December with a 90-day review window, which potentiall­y pushes the timeline for clinics to receive checks past March. Although clinics will eventually be able to ask for payment for services they provided as far back as August, when mpox was at its height, the more time that goes by, the less likely overburden­ed staff will be able to bill retroactiv­ely, Pulsipher said.

“It is extremely time-intensive to go back and submit those claims,” he said. “Some clinics will do that and some probably won't.”

Mpox outbreak today

California reported its first mpox case in Sacramento last May. What began as an isolated travelrela­ted infection quickly ballooned into a statewide outbreak, which peaked in August at 145 cases in one day, according to state data. More than 5,700 cases have been reported in California, the most of any state, including the country's first death.

“It would be hard to kind of overstate how frantic and frenetic and all-consuming it was at that point versus now,” Carpenter said.

In stark contrast, there were the two cases reported on Jan. 10, the most recent data available.

Although state officials

have not set an end date for California's state of emergency, the Department of Public Health plans to roll routine surveillan­ce and response duties into its Sexually Transmitte­d Disease Control Branch and Office of AIDS, according to an unsigned email from its media department.

“As cases decline, the outbreak comes under control, and the public health components for a robust response are fully operationa­l, there should be no impact to providers, (local health jurisdicti­ons), or patients of ending the state of emergency,” the email said.

But the end of the emergency does not mean “the end of disease,” Carpenter said. Plenty of L.A. LGBT Center patients are vaccinated during routine doctor's visits, often having been unaware of the outbreak and the need for protection.

“The virus isn't gone. It's not surging right now, but it's not gone, so we're at risk of a resurgence,” Carpenter said.

Pulsipher, with APLA Health, said his organizati­on is still working hard to educate and vaccinate Black and Latino patients, who often face the greatest health care barriers — even though the expense for that work will likely never be reimbursed.

“It's important to remain vigilant,” he said, “to continue outreach and education, continue to reach folks that aren't vaccinated and to recognize the inequities around vaccine uptake.”

Black and Latino California­ns account for 58% of all mpox cases but only 33% of all vaccinatio­ns, according to state data.

“What has become so clear between COVID and mpox is that one person's poor access to health care affects all of us,” Carpenter said. “That's, again, why we are not putting these vaccines down and going back to business as usual. Even within our own community we know that we still have a lot more work to do.”

 ?? LARRY VALENZUELA/CALMATTERS/CATCHLIGHT LOCAL ?? Fresno resident Gonzalo Garcia receives the mpox vaccine on Aug. 24, 2022.
LARRY VALENZUELA/CALMATTERS/CATCHLIGHT LOCAL Fresno resident Gonzalo Garcia receives the mpox vaccine on Aug. 24, 2022.

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