More than a month has passed since Congress allowed a crucial funding source for the country's federally qualified health centers to expire. Congressional efforts to reauthorize the money are still far from being realized, feeding concerns that the centers will have to start cutting services.
On Friday, the House passed the CHAMPION Act, which would reauthorize funding for the Community Health Center Fund for two years. The money would be part of a broader package that extends funding for the Children's Health Insurance Program for five years, and provides $1 billion in additional Medicaid appropriations to Puerto Rico.
The Community Health Center Fund accounts for more than 70% of the federal funding that the more than 1,400 community health centers across the country receive and makes up nearly a fifth of their total annual revenue.
But the bipartisan support the Community Health Center Fund usually receives was absent in Friday's vote, which split along party lines. Democrats, who mostly voted against the bill, argued the funding was paid for by redirecting funds from the Affordable Care Act's Prevention and Public Health Fund. That fund provides nearly $900 million in prevention grants to states and makes up roughly 12% of the Centers for Disease Control and Prevention's total annual budget.
Cuts proposed in the House are unlikely to pass in the Senate, where lawmakers have introduced a bill to extend community health center funding for five years. The Senate version does not propose taking money out of the Prevention Fund to offset the costs.
While many community health center officials remained hopeful Congress would eventually approve the funding, the continued uncertainty over when it may come has forced some providers to begin looking at what services they may need to cut in order to stay afloat.
"We can go for three more months and then after that we would have to start to curtail (services) immediately," said Dr. Van Breeding, director of clinical affairs for Mountain Comprehensive Health Corp., a community health center network based in Whitesburg, Ky., which serves 40,000 patients a year.
Breeding said Mountain formed a contingency task force immediately after Congress failed to reauthorize the CHC Fund before the Sept. 30 deadline. The group came up with a plan that would call for suspending operations in four of its seven clinics, and shutting down a number of specialized care services like optometry and dentistry.
Breeding estimated the loss of those services and sites would result in a 25% drop in its patient population, which would result in about 50,000 fewer office visits a year. If money from the fund did not arrive before Mountain exhausted its cash reserve, Breeding estimated as many as 100 jobs could be cut out of a workforce of 300 employees.
Uncertainty over the future of federal funding has been a growing concern expressed among patients as well. "They have come in and gotten their preventive-care services early," Breeding said. "They have come in to get their flu shots early, and they've gotten their medications filled for a year because they're very concerned about their treatment and their future treatment."
In Louisiana, community health centers throughout the state have been reluctant to begin new programs, according to Tiffany Netters, director of health policy and government affairs for the Louisiana Primary Care Association, which represents 34 federally funded community health centers operating 240 sites for nearly 385,000 patients annually.
An assessment the organization conducted last month of providers throughout the state found that many were preparing for staffing cuts of both clinical and administrative personnel as their first course of action to offset the loss of federal dollars.
"With the new bill, hopefully it goes all the way through," Netters said. "That would alleviate some of the pressure." But Netters said it would be "unfortunate" if community health center funding reauthorization came at the expense of the ACA's Prevention Fund, which pays for many of the state's chronic disease management and public health prevention initiatives.
"It's going to have major impact on the health of our community as well as the healthcare that they are provided through our clinicians," Netters said.
