Community Health Centers — Crucial to Medicaid Growth, Harbingers of Change

Andrew Kitchenman | August 13, 2015 | Health Care
Fast-growing health centers add more services for women, look to take on mental-health issues

Acting state Health Commissioner Cathleen Bennett
Healthcare systems are going through a revolution in New Jersey, and some of the places where change is most apparent are the state’s community health centers, often called FQHCs, or federally qualified health centers.

Since 472,506 people were added to Medicaid rolls in the past 19 months, New Jersey’s 20 centers have become even more critical. They are a main source of primary care for most Medicaid patients; as a result, many of these centers have been expanding the number of satellite locations they operate and the range of services they offer.

The role of FQHCs is frequently praised by senior state officials, including acting New Jersey Health Commissioner Cathleen Bennett, who recently attended one of her first public events to celebrate National Health Center Week and the 50th anniversary of the national launch of the program funding these centers. And as advocates for women’s health have criticized Gov. Chris Christie for cuts to Planned Parenthood and other family planning clinics, Christie has singled out these centers as being able to meet the healthcare needs of women and families.

Bennett noted that the centers provide screenings, immunizations, and other forms of preventive care that help residents head off serious illnesses. They “do a terrific job in tailoring services to best serve local residents,” she added.

But can they continue to do so? The centers face significant challenges in providing care while depending on Medicaid, the federally and state-funded program for low-income residents. And they are also seeking legislation that will allow them to deliver behavioral care under a single operating license. As of now, FHQCs cannot provide psychological counseling toto patients who would benefit from it.

In New Jersey, Medicaid reimbursements are among the lowest in the country in comparison with the Medicare program for seniors. That’s why executives who lead and advocate for these centers say they will be renewing efforts this fall to raise the reimbursement levels. They’re also looking to resolve a long-running court case over how the state funds some treatments.

Top industry advocate Jillian Hudspeth said the New Jersey centers are looking to make their reimbursements more equal to those in other states. New Jersey is 48th among the states in its ratio of Medicaid reimbursements compared with Medicare, according to the Kaiser Family Foundation.

Since last September, Hudspeth has served as the president and CEO of FQHC trade group the New Jersey Primary Care Association. She is careful not to criticize the state, which she said has supported the centers.

“We have good working relationships,” with state officials, Hudspeth said, adding: “We look forward to working with them to resolve some of these concerns.”

The centers serve 484,000 residents through 1.7 million patient visits annually, with 96 percent of patients having household incomes below 200 percent of the poverty line, or $23,540 for a single person and $36,375 for a family of four.

Dr. Kemi Alli, chief medical officer for the Trenton-based Henry J. Austin Health Center, noted the challenge for the centers in accommodating the newly insured.

“On the one hand, that’s amazing, that’s awesome,” she said of the large increase in enrollment.

But on the other hand, Alli said, some of the newly insured had delayed care and now are seeking care for serious health problems: “These are some of the sickest patients that we have.”

One way they’re meeting this demand is by opening new centers. The federal government announced $3.7 million in additional funding for nine new satellite locations. In addition, Newark Community Health Centers will mark the opening of its newly renovated, $12 million center in Newark’s North Ward today.

Dr. Theresa Berger, CEO of Lakewood-based center Ocean Health Initiatives Inc., noted that the range of services provided by the centers at the more than 120 locations that operate include on-site pharmacies, school-based healthcare, mobile health, social work, and insurance certifications. Her center alone has helped more than 11,000 people sign up for Medicaid or the individual health insurance marketplace under the Affordable Care Act. It hosted the anniversary event on Monday.

Berger, the NJPCA chairwoman, said that in addition to improving Medicaid reimbursements, the center’s have another major issue on the agenda: expanding into behavioral healthcare. One proposed bill would allow the centers to offer both primary care and behavioral healthcare with a single license.

“In internal medicine, they treat people for depression, but currently, as an FQHC we don’t have that right,” she said. “We should be able to provide primary behavioral healthcare, we’re not looking to provide all of the inpatient services — and there’s a huge spectrum — we only want that one little piece.”

In lobbying, the centers can draw on a great deal of good will that they’ve built with officials at both the state and federal levels. The bipartisan popularity of the centers was reinforced by the presence at the anniversary event of staff members for three different congressmen — U.S. Representatives Chris Smith (R-4th), Frank Pallone Jr. (D-6th), and Tom MacArthur (R-3rd).

Jackie Cornell-Bechelli, regional head for the U.S. Department of Health and Human Services, noted that the health centers are making their 50th anniversary at the same time as the Medicare and Medicaid programs. She drew a comparison between those programs, which were enacted over opposition in some parts of the country, and the current opposition to the ACA, passed five years ago.

“My hope and my anticipation is that 45 years from now, we will look back fondly at this period of time and see the strides that we made … because of the Affordable Care Act,” both because of the millions who became insured and the consumer protections included in the law, she said. She said that the benefits of the law are being implemented in the community health centers. She said her office is learning from the practices being developed at the community level.

“Without you, we couldn’t do any of the good work that we do,” Cornell-Bechelli said, addressing community center staff members at the anniversary event in Lakewood.