The state’s federally qualified health centers are taking on an increasingly important role in meeting the needs of low-income residents. They're also set for a round of legislative scrutiny.
When Gov. Chris Christie described his budget plans for healthcare in the coming year, he highlighted the $50 million that will support the FQHCs, which include 20 organizations that operate roughly 50 sites.
The FQHC designation was created in 1991 by the feds for community health centers that rely on a mix of federal and state funding. They have grown over time and are on schedule to increase their services next year, when the state adds more than 200,000 new Medicaid recipients.
Christie has said that he shifted funding from family-planning clinics to the FQHCs, a move that has brought criticism from family-planning advocates. In addition, legislators are raising concerns about the performance of some of the centers.
According to the governor, the centers provide high-quality care at an efficient price, and serve as an example of an effective use of government funding. FQHC funding has increased by $10 million, or 25 percent, under the Christie administration.
“If we want to try to control the cost of healthcare, we need to make healthcare steady and holistic and consistent and that’s what they’re doing here,” Christie said at a March 4 press conference at Metropolitan Family Health Network in Jersey City.
Christie said that his conversations with patients reinforced his administration’s theory that the FQHCs are a good channel for providing healthcare. He noted one mother who said her family uses the center for checkups, as well as for gynecological and dental visits.
“It doesn’t happen often, but when it does it’s really gratifying,” Christie said of residents receiving government-funded services at the same quality level in practice that they are supposed to receive in theory.
When asked if Christie has increased FQHC funding as a response to criticism from Democratic legislators that he cut funding to women’s health centers like those operated by Planned Parenthood, Christie said, “It was my decision, it was not a response.”
Christie said that when he was presented with a multibillion-dollar budget gap after taking office, he looked for areas to cut funding.
“My view is that the funding of Planned Parenthood clinics, in addition to the funding of federally qualified health clinics -- where women can get exactly the same treatment and more -- was duplicative spending,” Christie said.
More residents are receiving healthcare as a result, he said.
“What you have now is more people being served at federal-qualified health clinics than when I became governor and the reason for that is because we put our money where our mouth is on it,” Christie said.
“And so all they want to do," he continued, "is create wedge issues and divisiveness that goes with their cute slogans. Sorry, the facts don’t back it up and I’m going to stand by my record on this.”
Planned Parenthood Affiliates of New Jersey spokeswoman Michele Jaker said that state spending cuts have led to the closing of six family-planning and women’s health centers, including two operated by Planned Parenthood.
Jaker said that the increase in FQHC services hasn’t made up for the drop in patient visits to family-planning clinics as a result of government funding cuts. She added that even before the cuts occurred, all healthcare providers weren’t able to meet the demand for women’s healthcare.
“There’s nothing cute about eliminating funding for women’s healthcare providers,” Jaker said. “Planned Parenthood and other women’s healthcare providers specialize in reproductive healthcare and thousands of women rely on these services every day and that’s what's at stake here.”
Sen. Joseph F. Vitale (D-Middlesex), who opposed the cut to the family-planning clinics, reinforced the point.
“Family-planning clinics also provide primary care as well. It’s not only women’s health -- it’s holistic,” said Vitale, chairman of the Senate Health, Senior Citizens and Human Services Committee. “It’s families, it’s children, and it’s women.”
Vitale said both FQHCs and family-planning clinics should be supported because they are all needed in a state where there isn’t enough capacity to meet the need for primary-care providers.
“To spend on one type of care and not another, doesn’t solve the problem,” Vitale said.
Vitale wants to see FQHCs receive a closer look, since their financial reporting requirements are less stringent than those of hospitals, while their role in providing care is increasing. He is calling for every FQHC to undergo an independent forensic audit and is planning to hold a hearing on the subject in April.
“My experience is that there are FQHCs that do phenomenal work and my experience is also that there are also FQHCs who don’t,” Vitale said.
He also noted that FQHCs are reimbursed for every patient they treat, unlike hospitals.
“There is an ungodly amount of money being given to FQHCs and that’s great -- they provide care in so many ways to those who can’t get it anywhere else,” Vitale said. “But there has to be accountability.”
One FQHC that has grown rapidly is Newark Community Health Centers, which had 10,308 patient visits in January, up from 8,214 in the same month in 2012 and 6,255 in 2011.
The organization recently completed a $2.4 million federally funded renovation of its East Orange site and is currently undergoing a $6.4 million renovation of its headquarters on Broadway in Newark. The renovations will add 24 exam rooms and dental stations to the two centers.
When the Affordable Care Act goes into effect on January 1, 2014, “more people are going to have opportunities to have health insurance and they need someplace to go,” said Pamela Clark, acting CEO of the Newark Community Health Centers.
The Newark-based group recently reorganized, eliminating its marketing department and other positions, after posting an operating loss in 2010 and 2011, Clarke said. It has increased its focus on outreach, with an eye toward enrolling more residents in Medicare-funded insurance.
It’s also taken a major step toward increasing its efficiency by having more nurse practitioners deliver care. Clarke said that these professionals are well suited to evaluating patient needs in the context of their social and environmental challenges.
When practitioners ask how patients are doing, “for the people we serve, the answer is, ‘I don’t have a job’ or ‘I got laid off. And so I don’t have enough money to pay the rent, I don’t have enough to buy food,’ ” Clarke said. The centers’ doctors and nurse practitioners have to consider whether patients are in need of mental-health care or a visit with a nutritionist.
She said that increasing the number of patients who are insured would be crucial to allowing FQHCs to continue to grow.
“Things are changing and for us to do the right thing by our community, we have to educate the community” about Medicare and other insurance options, Clarke said.