- Community health centers (CHCs), which have faced expired funding since the end of September, 2017, are starting to consider cutting key services that would put patient access to care in jeopardy, according to a recent survey from the Kaiser Family Foundation.
These cuts would be a part of CHC efforts to stay afloat until the government reauthorizes full funding for the Community Health Center Fund (CHCF), a fund set up by the Affordable Care Act that has been the backbone of CHC growth in recent years.
Currently, CHCs offer primary care services, mental health services, dental services, and addiction treatment for over 25 million individuals nationwide. These entities are especially important in underserved rural and urban areas where patients have trouble accessing basic medical care.
CHCs have seen immense growth in recent years, including increases in funding from $1 billion in 2011 to $3.6 billion in 2017. This growth has allowed CHCs to better serve patients in need, KFF experts agree.
But that growth was stunted when Congress failed to reauthorize community health center and Children’s Health Insurance Program (CHIP) funding by September 30, 2017. Although CHIP saw a six-year extension in funding as a part of a recent continuing resolution, CHCs continue to fall by the wayside.
“Health centers have taken or are considering taking a number of actions that will affect their ability to serve their patients,” the KFF report stated.
About 70 percent of all CHCs have implemented or are seriously considering major efforts to curb their impending financial troubles. Most of these efforts currently focus on delaying or cancelling major investments and dipping into CHC savings.
“However, the longer the funding delay continues, the greater the likelihood health centers will be compelled to cut services and staff, actions they are currently considering but have not yet adopted in large numbers,” the survey revealed.
Twenty percent of community health centers have implemented a hiring freeze, and another 45 percent reported plans for a hiring freeze should funding issues not be resolved promptly.
Four percent of CHCs have laid off staff members, and other 53 percent are considering doing so in the future. Four percent of CHCs have also reduced staff hours, and 47 percent plan to do so soon. Thirty-six percent of CHCs plan on closing at least one care facility, while 3 percent have already done so.
Community health centers have also floated plans to cut patient services, a measure very few entities have actually taken but maintain will be essential should funding continue to be a problem.
Forty-five percent of CHCs said they would cut patient enabling services. Patient enabling services include translation or interpretation services, case management, or transportation services, and often support health equity. Health equity gives all individuals the same opportunity to achieve health, which is a key goal for community health centers.
Thirty-seven percent of CHCs say they will cut dental and mental health services, 36 percent will reduce medical services, and 14 percent will reduce pharmacy services.
Note that 30 percent of CHCs said they will have to cut addiction treatment services, a major step backward in the current fight against the opioid crisis.
According to KFF, continued lapses in CHC funding poses a serious threat to patient care access. Although few CHCs have actually resorted to cutting patient services, those cuts are forthcoming should CHCs continue without government funding.
“These cuts could reverse gains health centers have made in recent years in increasing patient care capacity and expanding the range of services they provide, particularly in the areas of mental health and addiction treatment,” the report noted.
“Health centers play a particularly important role in rural and medically underserved areas,” the KFF report concluded. “The failure to reauthorize the CHCF and restore health center funding could jeopardize access to care for millions of vulnerable patients.”
The government is not the sole source of funding for community health centers, to be clear. However, the CHCF does amount for about 20 percent of all CHC funding and enables CHCs to access external grants.
The CHCF is the second largest source of funding for community health centers, coming in second to Medicaid funding options. CHCF funds are especially important in rural areas and states that did not expand Medicaid because these places do not have a rich source of funding aside from the federal account.
Earlier this month, a coalition of 75 industry stakeholders called on Congress to address community health center funding, stating that the traditionally bi-partisan program helps support equal patient access to healthcare.
“These programs and policies enjoy strong bipartisan support and many have been approved for reauthorization and funding by the appropriate committees of jurisdiction, during the current Congress,” the group pointed out. “The continued lack of predictable funding for these programs and policies stands to negatively impact the lives of millions of people and communities all across the nation.”
At the time of publication, the House of Representatives is planning a vote for a continuing resolution that would provide billions of dollars in funding for community health centers. However, little has been discussed about the viability of a CHC funding vote in the Senate.