Media Round Up on Medicaid and the Funding Cliff

The past few days we’ve seen some interesting healthcare stories that are worth mentioning because in some measure they affect Community Health Centers and the patients they serve.

First, in Texas the primary care funding cliff again garnered headlines, with Liz Trevino, CEO with North Texas Area Community Health Centers, describing to Public News Service how many clinics would see funding declines of up to 70 percent if the Congress failed to act before the funding expires next year.   Trevino said, “The Texas decision not to expand Medicaid and not close the coverage gap left more than one-million uninsured who would have been able to enroll in coverage,” says Trevino. “So we’re treating that growing number of uninsured patients, but we won’t be able to do that if we don’t have the funding next year.”

Some 24 states have followed Texas in choosing not to expand Medicaid, and not only are they facing higher numbers of uninsured but also higher unpaid bills at hospitals.  The Huffington Post cites a report issued by the Department of Health and Human Services which shows that hospitals in the expansion states and the District of Columbia “will see $4.2 billion less in unpaid bills and charity care, a decrease of one-quarter. In the other states, the decline will be just $1.5 billion, or 9 percent.” [see story] We also note that the stakes are high health centers.  Over 36 percent of health center patients are uninsured nationwide, but in non-expansion states 41 percent of health center patients are uninsured and will continued to need care at a considerable cost.

Also, relating to developments in Medicaid,  Indiana University School of Medicine professor Aaron Carroll recently explained in the New York Times Blog “The Upshot” how federal regulators are now lifting a prohibition on asking people to pay premiums for Medicaid.  His conclusion:

  “Cost-sharing mechanisms are specifically intended to encourage people to consume less health care… a large body of research shows that increased cost-sharing leads to decreased utilization.”

Carroll also cites studies which demonstrated that cost-sharing premiums among those who can least afford them can discourage them from obtaining insurance and healthcare.

Stay tuned as we keep you posted on the latest news and happenings about health centers and the patients they serve.


Investing in Access to Primary Care

Why invest in primary care?  It’s a good question to pose as we see the healthcare marketplace changing around us.  Yes, more people have access to insurance coverage as a result of the Affordable Care Act, but just as important is having a place to go for care to stay healthy.

That is why the Department of Health and Human Services (HHS) has announced grants [press release] totaling more than $295 million to Community Health Centers last week.  Thanks to these funds, health centers can provide working families with better access to care by hiring an estimated 4,750 new staff including new health care providers, staying open for longer hours, and expanding the care they provide to include new services such as oral health, behavioral health, pharmacy, and vision services.  These investments will help health centers reach an estimated 1.5 million new patients nationwide, including over 137,000 oral health patients and more than 38,000 mental and substance abuse patients.

In a recent post, the NonProfit Quarterly (NPQ) noted:

 “Every health center I talk to around the country is bursting at the seams with new folks coming in to see them in states where they’ve expanded coverage like in California and New York,” said Dan Hawkins, NACHC’s Senior Vice President for Policy and Research in an interview with Modern HealthCare that was cited by NPQ.

Also, remember that while we know that demand for health centers will continue, the amount of funding in the future to support that expansion is uncertain. That is what we mean by the primary care funding cliff, which we’ve written about on this blog.

NPQ notes, “Without continued support from Congress, Hawkins predicts few health centers could continue their current level of operations. Community health center advocates and those concerned about health care access for vulnerable populations will be watching closely to see if the funding is sustained beyond next year.



HHS Announces $60 Million in Navigator Grant Awards: Health Centers are Among the Recipients


Westside Family Healthcare in Wilmington, DE, is among the Navigator grant recipients.

Ted Henson, NACHC’s Director of the Robert Wood Johnson Outreach and Enrollment Project, is today’s Guest Blogger on Health Center News and Happenings:

The Department of Health and Human Services has announced that $60 million in Navigator grants were awarded to 90 organizations in states with a Federally-facilitated or State Partnership Marketplace.

Community health centers and primary care associations were among the recipients of the Navigator awards, further solidifying the vital role that health centers play in enrolling the uninsured into health insurance coverage. Here is a list of health center-related organizations that received awards:

  • Alaska Primary Care Association
  • Arizona Association of Community Health Centers
  • Bi-State Primary Care Association (New Hampshire)
  • Kansas Association for the Medically Underserved
  • Madison County Community Health Centers, Inc. (Indiana)
  • Oklahoma Community Health Centers, Inc.
  • Pennsylvania Association of Community Health Centers
  • Westside Family Healthcare, Inc. (Delaware)

In most cases, the primary care associations and health centers will work with either other Navigator grantees or partner organizations to provide Navigator and enrollment services throughout the state. Navigators provide in-person assistance with enrollment for consumers shopping for and enrolling in plans through the Health Insurance Marketplace. The funding will help many health centers expand and strengthen the capacity of current outreach and education programs.

Madison County Community Health Centers in Indiana plans to provide outreach and education to consumers on a walk-in basis by utilizing a facility located in a heavy traffic location. In 2013, the Kansas Association for the Medically Underserved (KAMU) – the primary care association in the state – served as the lead agency and Navigator grantee for the Kansas Marketplace Consortium. Through the Navigator grant awards, KAMU plans to help the Consortium – which is a coalition of 427 locations that provide health and social services to the underserved – to recruit volunteers throughout the state to complete the Navigator training and provide enrollment assistance.

Read the HHS Press Release: HHS announces $60 million to help consumers navigate their health care coverage options in the Health Insurance Marketplace



More News Bites on the Primary Care Funding Cliff

Concerns about the primary care funding cliff are percolating on Capitol Hill, where U.S. Sen. Bernie Sanders (VT) has called for a bipartisan efforts to work toward a solution for the funding shortfall.

“Millions of Americans could lose access to community health centers,” Sanders said in a press release.  “Members of Congress will need to work in a bipartisan way to extend funding if we are to continue to provide Americans with the greatest health care needs a reliable source of primary care,” Sanders said. “Without access to affordable primary care, people put off going to a doctor until they get so sick they end up in expensive hospital emergency rooms.  In some cases they simply wait too long and their illness becomes terminal.”

The chairman of a Senate subcommittee on primary care, Sanders has introduced legislation to avert the funding cliff. His bill would authorize $25 billion over five years in new funding for health centers. Another $4.9 billion would be set aside from 2016 to 2020 for the National Health Service Corps to provide scholarships and loan repayments for health care professionals committed to practice in underserved areas. The measure also would increase the number of health centers providing residency training through the Teaching Health Center Graduate Medical Education program.

Sanders’ efforts caught the attention of the local newspaper, Bennington Banner, which ran an editorial in support.  “We agree with Sen. Sanders. The time to act is now… Successful navigation of this Primary Care Fiscal Cliff will only get more difficult as the end of fiscal 2015 nears.  The time to sound the trumpet is now.”

Of course, health center leaders are also making a case to newspapers and describing what funding cliff really means in human terms:

“The good news is that today over 20,000 more Delawareans have health insurance as compared to just a year ago, some of whom are insured for the very first time in their lives,” writes Lolita Lopez, President and CEO of Westside Family Healthcare in Wilmington, DE, in an op-ed published last month.   “Yet, although critically important, health insurance coverage alone does not guarantee access to care. Even more important, the progress we have made so far to improve access is now threatened here in Delaware, as well as in communities across the nation.”

Stay tuned to this blog for more updates about health centers and the funding cliff.


NACHC CHI Conference Highlights and Other News

wiltzIt has been a few days since the NACHC 2014 Community Health Institute (CHI) and EXPO wrapped up and everyone has gone home armed with new information and ideas. The advantage of the CHI is that thousands of health center leaders from around the country gather under one roof to network, exchange ideas, and hear from a variety of experts with trainings and education sessions. And there were a lot of sessions to choose from.

For instance, we sat in on a very good session about assessing the challenges and best practices from the last round of open enrollment. We learned from Leticia Cazares, Director of Outreach at San Ysidro Health Center in California, that one of the biggest challenges was misinformation and myths perpetuated in the media and elsewhere that often confused patients. Also, many health center patients did not realize that they could enroll in Medicaid throughout the year (if they qualified) or were eligible to enroll in the Health Insurance Marketplace through special enrollment periods as a result of certain life events.

The good news is open enrollment begins again on November 15 and already health centers are gearing up to assist patients with their insurance options. Also, we learned that Navigators and Certified Application Counselors have to be recertified every year and that certification expires in August for staff and volunteers of the Centers for Medicare & Medicaid Services’ (CMS) 2013 Navigator grantees in the Federally-Facilitated Marketplace (FFM) who completed training during the 2013-2014 grant period. The Health Resources and Services Administration (HRSA) is recommending health centers contact either their primary care association or state marketplace in non-FFM states to learn about the O&E assistance worker training requirements in their states. That is important information for health centers to know. As we’ve noted before, over 5 million people received enrollment assistance at their local health center to help them access coverage through the Affordable Care Act. This go around–the stakes are even higher as the enrollment season is shorter and the expectations are higher.

But back to the highlights…NACHC’s general sessions are a favorite for its information, speakers, and the nod to health center stars. The NACHC Community HealthCare Awards of Excellence are a regular feature.  This year’s honorees distinguished themselves in many aspects of healthcare delivery–innovation, research, public service, finance, education and training, and much more.

NACHC also honored Direct Relief, a humanitarian medical aid organization, for its unwavering commitment to supporting health centers across the United States that care for the nation’s most vulnerable people [see press release].

In his keynote address before accepting the award Direct Relief President and CEO Thomas Tighe told the audience, “there is no other nonprofit that has done what you do, as well as you do.”

Also a steady favorite at the general sessions is the update from HRSA.  Associate Administrator Jim Macrae brought health center leaders up-to-date on key health center issues just as the Department of Health and Human Services announced $35.7 million in Affordable Care Act funding to 147 health centers in 44 states, the District of Columbia, and Puerto Rico to support patient-centered medical homes (PCMH) through new construction and facility renovations. Nearly 50 percent of health centers have had at least one site recognized as a Patient Centered Medical Home (PCMH), and this latest investment will no doubt push those numbers higher.

Stay tuned for the next issue of the Community Health Forum, which will have a more detailed follow up about the 2014 NACHC CHI!