Despite new fiscal resources, community health centers face challenges post-ACA

Federally qualified health centers, commonly referred to as community health centers, have received new financial resources as a result of the ACA. However, the health law has also reinforced challenges for these centers, including the need for stable revenue streams, sufficient staffing support, and assistance in leveraging new reimbursement mechanisms, according to a new study from the UCLA Center for Health Policy Research.

The study is based on U.S. Health Resources and Services Administration data, as well as interviews conducted from 2014 to 2016 with the staff of 31 CHCs. The CHCs are in areas with high concentrations of uninsured and immigrant populations in New York and California, which have expanded Medicaid, and Georgia and Texas, which have not expanded Medicaid.

Researchers found most CHCs now see more patients post-ACA than they did prior to the health law. This contradicts some earlier projections that newly insured persons would leave CHCs for private providers.

Nationally, the number of insured patients using CHCs increased 35 percent, from 12 million in 2010 to 16.5 million in 2014, according to the study. In all four states studied, the total number of insured patients increased as well. The greatest growth occurred in California (from 1.67 million to 2.70 million, a 61 percent increase), followed by New York (1.05 to 1.44 million, 37 percent increase); Texas (440,000 to 630,000, 43 percent increase); and Georgia (157,000 to 198,000, 26 percent increase), according to the study.

"Most CHCs saw an increase in the number of insured patients, both because they retained previous patients who became insured and because they attracted new insured patients," researchers wrote.

At the same time, the total number of uninsured CHC patients in Georgia and Texas increased from 2010 to 2014, while New York experienced a modest decline, from 368,000 to 329,000, the study shows. California showed a significant decline in the number of uninsured served by CHCs as well, though more than 1 million patients remained uninsured.

The study also found the number of immigrants seeking care at CHCs grew 12 percent between 2010 and 2014, to 5.3 million. The 31 CHCs studied also reported that a common reason patients were ineligible for insurance was their legal status.

Additionally, the study found federal grants thta were awarded as a result of the ACA provided needed funding to help serve the growing numbers of people using CHCs, particularly in states that didn't expand Medicaid, according to a news release.

However, much of the additional funding is temporary, so clinics face significant financial challenges in the future and need stable revenue streams, the news release states. Also, many clinics are unsure how changes in Medicaid reimbursement policies will affect them financially.

As far as staffing, the ACA requires more specialized paperwork to track service quality, computerized patient record keeping and other administrative tasks, and that cost is not reimbursed, the news release notes.

"The financial success of community health centers depends on their ability to successfully improve quality and coordinate care, and these improvements will require staff and resources," Nadereh Pourat, director of research at the UCLA Center for Health Policy Research, said in a statement. "When patients are high-need, CHCs have to hire more staff and use more resources to be successful. And that costs money."

The study, supported by the Commonwealth Fund, also reports CHCs face difficulties recruiting and retaining registered nurses and physicians, because clinic salaries are less competitive than in private industry.

The authors of the study recommend both state and federal policy permanently maintain and enhance core federal funding for CHCs, insure the remaining uninsured in both expansion and non-expansion states, increase workforce availability by reimbursing CHCs for essential nonclinical services, and help CHCs prepare for changes in Medicaid reimbursement policies.

 

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