All three of Leticia Aguilar’s children got their shots at the Sacramento Native American Health Center. After her mother had a stroke, Aguilar took her there for every follow-up appointment. Aguilar and her husband got sober there. Now they take classes there that link them to their culture.
For Aguilar, it is irreplaceable as a health center and a community center.
But the midtown Sacramento clinic and more than 1,200 other health centers across California, many in isolated, rural communities, are at risk of closing or undergoing drastic changes if Congress enacts pending legislation to replace Obamacare, advocates say. The measure envisions huge cuts to Medicaid (Medi-Cal in California), the health program for the poor, that pays many of the centers’ bills.
In Washington, the Republican-backed legislation remains short of the votes it needs to clear the U.S. Senate. In California, state lawmakers and Treasurer John Chiang last month moved to create a safety net for the clinics in case the current version of the federal bill becomes law.
On Monday, Gov. Jerry Brown signed the budget-related bill that included $20 million for 80 one-time emergency grants to help the clinics get by while they find long-term funding solutions so the more than 4 million Medi-Cal beneficiaries who get their care from community clinics still receive services.
The grant program is an effort to preempt drastic changes to the nation’s longest-running health support system, providing funding for core operations at clinics that would be affected by cuts to Medicaid.
When awarded, the $250,000 grants will act as a “stop-gap until the clinics develop a more long-term sustainable financing plan such as increasing private foundations and business support, merging with other providers and developing public-private partnerships,” said Shawn Brouwer, a spokesman for Chiang.
The money will come from interest accrued in an existing loan program, also operated by the Treasurer’s Office, that lends money to small clinics for one-time expenses like land and equipment purchases.
The effect of cuts on small clinics could be greater now than it would have been a few years ago. Because Obamacare greatly expanded eligibility for Medi-Cal, many of the small clinics grew to accommodate more patients – and now stand to lose much more.
The one-time grants could come as a welcome relief to a clinic like the Sacramento Native American center, which, despite being one of over two dozen primary care clinic options in Sacramento County, has a devoted base of patients.
Because it is a nonprofit Federally Qualified Health Center, 90 percent of its patients are covered by Medi-Cal or Medi-Cal managed care, according to CEO Britta Guerrero. Given its expansion this year and reliance on Medi-Cal reimbursement to pay the bills, any lost funding would result in a “cut of many services that we’ve added that are so desperately needed,” said Guerrero. “To lose the Medi-Cal coverage for the expanded population, it would be catastrophic for the Sacramento community – not just our clinic, but there are multiple clinics that would be impacted by such a change.”
The grant program will favor clinics in small, rural communities like Colusa or Arbuckle. Fourteen are run by Ampla Health in California.
“In all the communities we’re in, we are the largest healthcare provider for the Medi-Cal population,” said John Fleming, director of Planning and Development for the Ampla Health system, which serves approximately 70,000 patients annually. He estimates that at least six of their clinics would be at risk if funding from the state and from D.C. was significantly cut, reducing services for more than 50,000 Medi-Cal, Medicare and seasonal worker patients in the system.
For Ampla Health, the $250,000 would subsidize operations and ensure care for newly under-covered individuals while the system seeks out more durable funding.
Planned Parenthood affiliates are also eligible for the grant program because of the threats they face from the federal anti-abortion climate. This – combined with low Medicaid reimbursement rates – has already led to reduced services in some locations and the shuttering of three clinics in Vacaville, Pittsburgh and Richmond.
While the state budget will provide some relief to women’s health providers and to physicians who serve Medicaid patients, money from the Community Clinic Lifeline Grant Program could prevent eligible Planned Parenthood clinics from closing if funding from the federal level is cut.
Some Californians believe Planned Parenthood should be excluded from the program because of its abortion services.
“If this is just a funding stream that is earmarked for Planned Parenthood, that is unsettling and unfair and not putting women’s health as a priority for our state,” said Wynette Sills, director of Californians for Life. “The money could be very well-utilized by the smaller, more rural healthcare providers – the non-abortion healthcare clinics that provide comprehensive healthcare for women and their families.”
Sills said she believes that the Planned Parenthood clinics are easily replaceable by ones she supports, like the Elica Health Centers across Sacramento, which do not provide abortion services.
But Kathy Kneer, former president and CEO of Planned Parenthood Affiliates of California, said the clinics provide far more than just abortions, which represent 3 percent of their total services, and are still many low-income women’s first choices for care.
“Patients choose to come to Planned Parenthood because they want non-biased, accurate and non-judgmental information,” she said. “And part of the reason we do extended hours and work on weekends is, we’re trying to build services around the patient’s needs.”
The organization’s 20 remaining sites across California offer screenings for sexually transmitted infections, breast and cervical cancers, prenatal care and family planning. Patients will suffer, Kneer said, if specifically trained clinicians who can deal with special cases like family planning in domestic abuse situations are not available to patients through Planned Parenthood affiliates.
The patients at community clinics aren’t the only ones at risk, advocates say. With the closures of clinics come lost jobs and shaken economies, according to Carmela Castellano-Garcia, president of the California Primary Care Association and California HealthPlus Advocates.
“This funding will help prevent community health center closures,” Castellano-Garcia said. “It can take up to a year to hire a doctor for a community health center. Once a clinic is closed, you’ve lost those doctors, you’ve lost that staff and you’ve lost that infrastructure.”
For Federally Qualified Health Centers and the communities around other safety-net clinics in California, a repeal of the Affordable Care Act could mean a $3.8 billion economic reduction and a loss of over 27,000 jobs in health centers alone.
It would also amass $3.5 billion in costs to the health system because formerly covered patients will seek care at hospitals or delay care until they have costlier problems, according to Capital Link, a nonprofit that works with health centers and the Primary Care Association.
Over the next six months, application guidelines will be made available to eligible clinics. Grants will be awarded regardless of what happens at the federal level.
Rennie Svirnovskiy, 916-321-1310, @RennieYS