‘Uncertainty Has Been All-Consuming’: Community Health Centers Face Funding Cliff

Despite a groundswell of bipartisan support, funding for community health centers remains an outstanding issue just over a week from another potential government shutdown.

Regional community health center (CHC) leaders are still operating as usual, even as the threat of another government shutdown and a lack of long-term federal funding loom overhead.

Anxiety surrounding a potential reduction in service sites, staffing, and available care capacity is palpable this week in conversations with CHC advocates facing an unclear future.

“There’s a lot of noise in Washington, D.C., right now, and health centers are getting lost in that noise,” said Amy Behnke, CEO of Health Center Association of Nebraska, the state’s primary care organization assisting CHCs. “I think there’s a level of anxiety and frustration that the inaction is not due to a lack of support for the program, it’s just not being able to get it done.”

The Community Health Center Fund (CHCF), created in 2010 as part of the Affordable Care Act, is the largest source of comprehensive primary care for medically underserved communities, according to the Kaiser Family Foundation.

There are currently 1,367 health centers operating at more than 10,400 sites across the country, providing care to 26 million patients, according to the Health Resources and Services Administration.

CHCF receives $3.6 billion in federal funding each year, constituting 70% of its operating revenue. The remaining 30%, $1.5 billion, is supplied by annual congressional appropriations. Federal funding for the CHCF lapsed in October, with only temporary spending measures supplying CHCs with enough money to last through the end of March.

If Congress does not approve additional funding, nearly 25% of service sites are projected to close, resulting in layoffs for 51,000 staffers, and reducing the patient care capacity by 9 million people, according to Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law and Policy at the George Washington University School of Public Health and Health Services.

Behnke said the “uncertainty has been all-consuming” since funding ran out, and she has not received any clear indication about what progress is being made on Capitol Hill.

CHCs, like any other business, face challenges when its funding future is unknown, she said. This hampers efforts to expand service sites, hire new employees, and even schedule treatments for patients with chronic illnesses.

Most CHCs are not aligned with major health systems; none of the seven CHCs or 42 service sites in Nebraska are affiliated with a major hospital.

Some CHCs in Nebraska have contingency plans, which include imposing hiring freezes, reducing hours, and limiting available services. Behnke said funding challenges could force one CHC site located in an Omaha public housing tower to fold back into the main clinic to reduce costs. Such a situation would create transportation problems and confusion among patients, she said.

Patients deprived of access to CHCs face two options, Behnke added: using the ER when they’re sick or forgoing healthcare altogether. In the latter situation, patient conditions can spiral out of control, which also affects providers once costs begin to mount, she said.

Hospitals have an interest in seeing CHCs fully funded since the facilities are widely regarded as providing patients with affordable and high-quality care. Health systems seeking to reduce readmission rates, considering visits to the ER result in lower reimbursement rates, especially for Medicare patients, are better served having CHCs assist those communities.

“Health centers are key partners because they are an open door and have boots on the ground in the communities where they are the primary care medical home for many of the most underserved and hardest-to-reach patients,” said Suzanne Cohen, senior director of population health for the Health Federation of Philadelphia, a network of CHCs.

Cohen remains concerned about the 9 million patients who could lose access to treatment if the funding situation is not rectified. This worry extends to both rural communities, which might have access to only one CHC due to geographic location, as well as urban communities, where there is already high demand among low-income populations.

For a facility to apply as a federally qualified health center, all expenses must be submitted for what Cohen referred to as federal “wrap-around dollars.” Each CHC has its own customized funding plan, which Cohen said doesn’t include “much fat,” since a CHC could not operate solely off of traditional reimbursement rates.

Without action from Congress, difficult decisions for CHCs become even more pressing, Cohen said. Despite the pressing situation, however, Cohen remains “cautiously optimistic” that Congress will fund CHCs in the next spending resolution.