NYAPRS Note: Community Health Centers are known nation-wide to most often be sites of integrated care and connections to social services. This is born out of necessity; a large proportion of care recipients are uninsured, and often require attention to behavioral health needs and other health determinants like housing and legal services. The article below highlights the way the ACA is both challenging these centers (by stressing already high demand for providers) but also providing promise; expanded Medicaid allowances could mean more reliable funding, increased access to services for many community members, and flexible funding provisions that could help centers innovate and build best practices. In NY, community health centers are looking into possibilities to integrate peer services and crisis outreach in order to better serve community members beyond their walls. Community Health Centers should be an excellent resource in DSRIP networks, particularly where they have strong ties to mental health and substance abuse providers in the community.
Reform Update: Community Health Centers Brace for Influx of Newly Insured
Modern Healthcare; Andis Robeznieks, 3/31/2014
The nation’s 9,000 community health center locations, serving some 22 million patients, are bracing for an influx of patients in the 26 states that have expanded Medicaid under the Affordable Care Act.
Roughly 10,000 physicians make up about 60% of the community center clinical workforce; their work is supplemented by about 6,000 nurse practitioners and physician assistants, noted Dan Hawkins, policy director for the National Association of Community Health Centers. He is not sure if this will be enough for what he expects will be increased demand for services.
Of the 22 million patients who sought care at a community health center last year, Hawkins said, about 8 million, or 40%, were on Medicaid, while about 36% were uninsured. “The hope is that they will qualify for Medicaid,” Hawkins said.
“In Michigan, we’re extremely excited,” said Stevi Riel, operations manager for the Muskegon (Mich.) Community Health Project, which oversees community health centers for Mercy Health, a division of the Catholic Health East/Trinity Health system.
“We’re certainly going to have more people seeking access,” she said. That includes new patients and an increase in visits from established patients.
“A couple hundred” people enrolled in the Medicaid program at three Mercy sites this past weekend in Muskegon and Grand Rapids, Riel said. That included many in the 19- to 26-year-old range.
“Certainly, provider shortages are on everybody’s mind,” Riel said, adding that Mercy has been actively recruiting for more primary-care doctors and has worked to increase efficiency with medical-home care teams.
Sip Mouden, CEO of Community Health Centers of Arkansas, said Medicaid expansion is expected to cut the state’s uninsured population in half with 200,000 to 250,000 expected to enroll in either traditional Medicaid or the state’s “public option” plan, which uses federal Medicaid funds to purchase private insurance for low-income residents.
She said assisters at community health centers, paid with either federal funds or state insurance department grants, had helped almost 25,000 people with the enrollment process from June through December.
It’s unknown, however, how many of those actually enrolled. Figures for January through March are expected to be much higher.
There has been a general hesitancy in Arkansas to sign up for new health insurance options, Mouden said. Some are concerned that, even after enrolling, there will be expenses they can’t afford, she explained. For those with higher incomes who would be seeking coverage through the health insurance exchange, “there’s still some skepticism” that the individual insurance mandate will be enforced and they will be penalized for not buying insurance, she added.
After Massachusetts implemented health reforms that widened insurance coverage to state residents, Mouden said 20% to 25% of patients at the state health centers remained uninsured. She expects the same to happen in Arkansas, only the figure could be as high as 35%.
“I don’t think we’ll be far off,” Mouden said.
That said, she added that the state’s 12 community health center organizations—which have 88 locations—have done their part to lower that number.
“We’ve done a tremendous amount of outreach,” Mouden said. This included advertising, telephone calls, going door to door and holding community forums.