Health clinics struggle to remain open.

Clinics that care for the poor have had to furlough or lay off workers amid steep declines in patient visits

As Bay Area residents and public officials grapple with the coronavirus, the community health clinics that serve some of the region’s most vulnerable residents are dealing with a challenge of their own: how to keep their doors open while patient visits plummet during the shelter-in-place mandate to reduce the spread of the virus.

Patient visits are down by roughly half across California’s network of community clinics and health centers, leading to tens of millions in lost revenue each week.

For many local health clinics that primarily serve low-income residents and rely on Medicaid reimbursements to make up a large portion of their income, the dramatic reductions in patient visits threaten their ability to stay open and care for the kinds of patients who are at a heightened risk of contracting the virus.

Experts say the Bay Area, which has been in a state of lockdown longer than anywhere else in the nation, has been particularly affected, with some instituting furloughs or layoffs.

“The Bay Area clinics are hard hit,’ said Carmela Castellano-Garcia, president and chief executive of the California Primary Care Association.

There are about 1,300 community clinics and health centers (CCHCs) across California serving more than 7 million patients annually — nearly one-sixth of the state’s population.

Many provide care to residents particularly at risk of contracting the coronavirus or uniquely vulnerable to it. Community health centers serve roughly 1 in every 3 Medi-Cal recipients and in 2019 worked with 486,628 migrant workers and 246,268 homeless residents, according to CPCA.

With patient visits down, Castellano-Garcia says California’s CCHCs are collectively losing about $90 million a week. Up to 77 health centers statewide may not be able to make payroll within 90 days if the trends persist.

“It is not sustainable,” she said. In the South Bay, patient visits at Gardner Health Services, which works in Santa Clara and San Mateo counties, have dropped nearly 60%, says Chief Operating Officer

“This is financially a very difficult time, there is no way of sugarcoating this. We are analyzing sustainability on a day-today basis.”

— Marc Gannon, chief operating officer of Fremont’s Tri-City Health Center

Efrain Coria, prompting financial losses of about $1 million a month. Gardner has reduced its workforce by about 22%, Coria says, and laid off 135 staff members, though he emphasizes he hopes to rehire many of them in the coming months when and if things calm down.

In the East Bay, La Clínica de La Raza, which serves about 90,000 patients annually in clinics throughout Contra Costa, Alameda and Solano counties, has seen in-person visits drop about 30% since the start of the pandemic, says CEO Jane Garcia, resulting in financial losses of about $3 million over the past month. About 300 employees have been furloughed.

However, La Clínica’s health centers have seen some gains since the state eased some restrictions for telehealth services, allowing patients to connect with health providers electronically.

Those visits are also billable to Medicaid.

“If that option had not been authorized, it would have shut us down,” Garcia said. “And you would have seen (the patients) in emergency rooms and hospitals, or they wouldn’t have gone in at all.”

Marc Gannon, chief operating officer of Fremont’s Tri-City Health Center, which serves about 26,000 patients in Fremont, Hayward, Union City, Newark and San Leandro — 37% of whom are on Medi-Cal or are uninsured, and the majority of whom live below 200% of the federal poverty level — says the organization changed its business model “essentially overnight” from in-person visits to telehealth appointments.

But the health center is still suffering declines in revenue. In-patient visits have decreased by about 35% since the start of the pandemic and, Gannon says, the clinics are considering reducing staffing to manage the financial hit.

“This is financially a very difficult time, there is no way of sugarcoating this,” Gannon said. “We are analyzing sustainability on a day-to-day basis.”

Amid the financial challenges, Tri-City health care workers are trying to check in with patients by phone, providing resources from Medi-Cal and other safety net services that they may be eligible for, or behavioral health services for people struggling with isolation and loneliness due to shelter-in-place orders.

Last week, they reached 3,000 of the network’s 26,000 patients.

The federal government recently granted the nation’s federally funded community health centers a reprieve, awarding $1.32 billion to health centers nationwide.

But many say that’s not enough to cover their losses. The $1.3 million the South Bay’s Gardner Health Services expects to receive, which is supposed to cover a 12-month period, would last five to six weeks, Coria says.

Still, Bay Area community health centers want to make sure that people know their doors — virtually and physically — are open to people who need care.

“Community health centers are adaptive, resilient, and have been around for a very long time,” said Gannon. “We are going to survive this.”