Community clinics face funding loss

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Community health centers — clinics offering a variety of medical, dental and mental health services on a sliding-fee basis — serve 140,000 patients across Dauphin, Cumberland, Lancaster, York and Franklin counties and employ 1,000 people.

Such clinics depend on the federal Community Health Center Fund for up to 70 percent of their grant funding, according to the Pennsylvania Association of Community Health Centers. In 2016, Pennsylvania received $67.4 million in grants from the fund, which issued $3.6 billion nationwide last year.

Much as it did with the Children’s Health Insurance Program, Congress let the fund expire in September only to pass a temporary measure in December. If Congress doesn’t act by Jan. 18, clinics could be forced to cut back services and deny patients care.

“Without those dollars, we would not be able to maintain the sites and services we currently offer,” warned Jenny Englerth, CEO of Family First Health, which serves over 22,000 low-income patients at its locations in York, Hanover, Gettysburg and Columbia.

In order to receive grants from the fund, clinics like Family First must apply for federal status as a Health Center Program through the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services.

In their application, clinics must meet 19 points of eligibility including regional need, patient involvement in their governing board and a refusal to turn away any patient if they lack the ability to pay. To patients with an annual income at or below the federal poverty level, clinics must offer treatment for free.

For Englerth, a failure to renew the fund represents a failure by Congress to keep up its end of the bargain.

“We fulfill many requirements in order to maintain that designation,” said Englerth. “Then the receipt of that grant money allows us to support the reduced-fee program that we’re required to offer as a federally designated health center.”

Englerth warns community health centers could face multiple funding declines if current political trends continue.

“I hear conversations in this new year about reducing Medicaid again,” said Englerth. “If we’re not going to reauthorize CHIP, reduce Medicaid and reduce funding, it will severely and dramatically limit the amount of care that we’re able to provide as a health center to the communities that have grown to count on us as a primary care provider.”

In 2016, Family First reported revenue of $17.7 million, more than a third of which came from Medicaid and CHIP reimbursements. Another $5 million came from grants, the loss of which would severely limit Family First’s ability to deliver the more than $1 million in charity care the clinic provided across its six locations.

According to Jeannine Peterson, CEO of Harrisburg clinic Hamilton Health Center, the loss of the fund and CHIP would represent a “catastrophic” impact for clinics like Hamilton and Family First.

“Here we are now faced with two major forms of revenue that we won’t have,” said Peterson. “There is just no way community health centers would be able to pick up that additional population that’s uninsured.”

According to its most recent annual report, Hamilton Health Center serves over 26,000 patients at its main campus in the Allison Hill neighborhood, 58 percent of whom depend on Medicaid or CHIP for their health insurance. A third have no insurance coverage at all. If a patient lacks insurance and lives below the poverty line — a situation facing 77 percent of Hamilton patients — the center foots the bill.

If her clinic is forced to cut services, said Peterson, “The response from families will be to get health from the emergency room, and that’s exactly what we don’t want them to do. That will be so much more costly than getting primary care at our centers.”

Because the fund could end at the same time as CHIP, children could be disproportionately affected by the lack of movement in Congress.

“That’s motherhood and apple pie for this country,” said Peterson. “And yet we’re not getting any action.”

When reached for comment, Pennsylvania Sen. Bob Casey (D) blamed inaction on the fund on “Washington Republicans’ promises to donors to overlook deadlines affecting middle-class Americans and those trying to get there to provide gigantic tax cuts for the super-rich and corporations.”

He added: “I will continue to fight for these centers’ funding to be reauthorized.”

Sen. Pat Toomey (R) expressed confidence a deal would be reached before the Jan. 18 deadline. But, he added, “It is helpful to remember that Obamacare dramatically altered the way that federal qualified health centers are financed and created these periodic funding cliffs.”

According to Jim Willshire, policy director for the Pennsylvania Association of Community Health Centers, every congressional delegation the trade organization has met with voiced support for community health centers, only to leave them disappointed as deadlines approach.

“We’re told ‘we support health centers,’” said Willshire, “But then we hear all the other issues that are out there in Washington. Everything from building the wall to avoiding a government shutdown to the Dreamers. The focus is lost when all the other issues are being thrown into the mix.”

Because of those assurances from lawmakers, many clinics set their budgets for the current year based on the assumption they could count on the renewal of the Community Health Center Fund.

“They weren’t in a position where they could assume that funding wouldn’t come through,” said Willshire. “Every one of the meetings we’ve had with all of our congressional delegations, all of them said, ‘We love the work you’re doing,’ all of them have publicly supported health centers. All assurances were given we wouldn’t be where we are today.”

Where CHIP stands

Funding for the Children’s Health Insurance Program, or CHIP, expired on Sept. 30 but was extended by Congress in a continuing resolution passed last month,

Congress must approve more funding for the program before Jan. 19 or CHIP programs like the one in Pennsylvania will lose 90 percent of their funding.

The Pennsylvania Department of Human Services, which implements the program, is currently evaluating when it will send end-of-coverage notices to families of the more than 180,000 children enrolled in the program but emphasized it will give 30 days notice.