Community health centers are scrambling to make contingency plans as they anxiously wait to see if Congress will renew billions of dollars in federal funding that expired on Sept. 30.
Often situated in medically underserved areas, the health centers provide care to some 26 million of the nation’s most vulnerable people. They’re required to take any patient who seeks care, regardless of whether they can pay.
But the funding uncertainty is causing problems for health centers. Some are instituting hiring freezes and having trouble recruiting and retaining employees.
“The uncertainty is so challenging for our members,” said Rose Duhan, CEO of the Community Health Care Association of New York State.
She added: “Not having the certainty of what's going to happen less than a month from now is just very difficult to do any kind of planning.”
At issue is a fund that ObamaCare created for community health centers, a noncontroversial element of a politically charged law. This new pot of money accounts for about 70 percent of health centers’ federal dollars, and in 2015, Congress renewed the funds to the tune of a total of $7.2 billion over two years.
Although lawmakers from both sides of the aisle support funding health centers, Congress let the authorization lapse Sept. 30. Health centers haven’t received less money yet, but that could happen soon, as 25 percent of health centers have new grant periods that begin on Jan. 1 and another 17 percent have them on Feb. 1, according to a Health Resources and Services Administration (HRSA) spokesperson.
HRSA is also planning to step in if needed to help keep the funding going as long as possible for those with grants expiring early in the new year. The agency anticipates providing short-term continuation grants on a month-to-month basis, but it wouldn’t be the full amount. The dollars would be prorated at a to-be-determined level, according to a spokesperson.
It’s unclear how long HRSA would be able to continue the grants. A spokesperson said the money would come from available fiscal 2018 discretionary appropriations and remaining mandatory funds and continue until they’re depleted.
That’s putting health centers in a tough spot.
“Now we're at the stage where a lot of those health center executives and boards are talking about what they're going to do, especially provided that nothing happens over the month of December,” said Jim Willshier, director of policy and partnership at Pennsylvania Association of Community Health Centers.
Health centers are the nation’s largest source of comprehensive primary care for medically underserved communities, and if funding lapses, “they'll just be a lot of hard decisions that health centers will have to make,” said Julie DiRossi-King, chief operations officer of Ohio Association of Community Health Centers.
A health center in the relatively rural Finger Lakes region in New York now has a pediatric dental and tele-dental program — a direct result of the health center fund. A funding lapse could mean eliminating or scaling back that service.
Another New York clinic serving Hudson Valley and Long Island used the federal grant money to begin a medication-assisted treatment program to help those with an opioid addiction. The opioid crisis has ravaged communities across the country, leading to a significant uptick in overdose-related deaths.
“If they don’t have that funding in place, they're going to not be able to continue to offer that program where they know there's a huge need,” Duhan said, referring to the center serving patients in Hudson Valley and Long Island.
A health center in Pittsburgh also recently added a medication-assisted opioid treatment program and would have to stop administering the medicine with the hope of continuing counseling. Without the federal funding, an Allentown, Pa., site also plans to leave a program that helps it administer treatment to 100 people with an opioid addiction, Willshier said.
If funds aren’t appropriated by Jan. 1, about 72 percent of health centers across the country plan to put a hiring freeze in place — and some already have.
Health centers are considering or already instituting other measures: Roughly 41 percent would lay off staff, 47 percent would reduce their staff hours and/or hours of operation, and slightly more than half would cancel or delay renovating or expanding their facility. That’s according to a survey by the National Association of Community Health Centers performed a few days before the reauthorization expired.
Health centers say they’re cautiously optimistic new funding will pass by the end of the year, though there’s no guarantee it will happen.
The House passed a bill providing two years of funding for community health centers, five years for the Children’s Health Insurance Program and an extension for other public health programs. It passed on a largely party-line vote, with Democrats criticizing how Republicans planned to pay for the reauthorizations.
The Senate hasn’t passed any legislation, though there’s a bipartisan bill from Sens. Debbie StabenowDeborah (Debbie) Ann StabenowSenate Democrats dial down the Manchin tension Democrats surprised, caught off guard by 'framework' deal Congress facing shutdown, debt crisis with no plan B MORE (D-Mich.) and Roy BluntRoy Dean BluntIt's time to make access to quality kidney care accessible and equitable for all Hartzler pulls in 6,000 for Missouri Senate bid with .65M on hand McConnell gets GOP wake-up call MORE (R-Mo.) to provide five years of funding.
The year-end spending measure is a potential vehicle for the health center money — yet community health centers wish lawmakers hadn’t let the funding lapse in the first place, particularly because the clinics have bipartisan backing.
Based in Moorhead, Minn., Community Health Service Inc. operates four year-round clinics, two mobile units and a seasonal clinic, all of which could face substantial cuts. About 85 percent of its patients are uninsured, which means the federal dollars comprise a significant portion of its money.
“Everybody likes us, but nobody wants to invite us to the party. It kind of stinks,” Kristi Halvarson, executive director of Community Health Service Inc., said of the bipartisan support for community health centers.
“It makes us hopeful, but still there’s tremendous uncertainty that, yeah, we might get it done by the end of the year, but is that too late? Because then I still only have a month to potentially look at what my staffing and clinic set up look like,” she said.