Community health centers, which serve more than 500,000 mostly low-income patients a year in Colorado, could be forced to make significant cuts unless Congress renews their funding in the coming weeks.
The funding — about $63 million per year in Colorado — lapsed last year around the same time as did money for the Children’s Health Insurance Program, which provides insurance to kids from low-income families. But, while Congress renewed funding for CHIP last week as part of a deal to end the federal government shutdown, it provided no solution for community health centers, where many kids on CHIP go to receive care.
That creates what is, for advocates of the centers, the mind-boggling possibility that the nation is about to lurch from one looming health care crisis to another, all because Congress has not acted to reauthorize money for what are widely supported programs. Last year, when the funding for the centers first expired, dozens of members of Congress from both chambers sent bi-partisan letters to leadership urging swift resolution of the issue. Every member of Colorado’s congressional delegation supports extending the centers’ funding, according to the Colorado Community Health Network.
“If these kids don’t have anywhere to get their health care, it’s really pointless to give them health insurance,” U.S. Rep. Diana DeGette, a Denver Democrat, said Thursday at a news conference at Denver Health’s Sam Sandos Westside Family Health Center.
Colorado has 20 community health centers that provide services at more than 200 locations, in both urban and rural areas. The centers primarily serve low-income families, many of whom are on Medicaid or Medicare — which pay providers notoriously low rates for their care. Other patients at the centers are uninsured.
To help the centers stay afloat, the federal government has for years provided extra money to the centers. Over the 2016 and 2017 fiscal years, Congress authorized $3.6 billion from a special fund to go to the centers nationwide. But that fund expired at the end of September. Since then, money has been provided on a short-term basis, but that will run out in March.
“We’re not certain if there’s going to be funding at all past March,” said Polly Anderson, the vice president of strategy and financing for the Colorado Community Health Network.
The instability is already having an impact at community health centers across Colorado.
In Denver, about one-third of children receive their medical care through one of Denver Health’s network for community health centers, said Robin Wittenstein, Denver Health’s CEO. But uncertainty over how much money will be available for the centers in the future has Denver Health moving more cautiously in its plans to expand services.
And if the money doesn’t come through, Wittenstein said Denver Health will probably have to cut back on staff and services at the centers, even though that could mean patients would receive more costly care in the emergency room rather than cheaper primary care at the centers.
“It will have an impact on health status long-term and health cost long-term,” she said.
Asked which services are most vulnerable to cuts, Dr. Steve Federico, Denver Health’s director of general pediatrics, gave the example of a 2-year-old who is slow to start talking. Currently, that child would be eligible for speech therapy programs at home. Those might not survive if Congress doesn’t provide more money, he said.
“Medicine is now a team sport, and these funds are what allow us to create that team,” he said.
The problems don’t just exist in Denver.
In Colorado’s mountain towns, home to some of the nation’s highest health care costs, community health centers are often the only options available for low-income families to receive primary care, said Garry Schalla, the development director at Mountain Family Health Centers. His center has eight different locations — from Edwards to Parachute — and serves 19,000 people a year, providing everything from doctor check-ups to dental care to behavioral health services.
The annual budget for the center is $18 million, he said. The federal funding cuts could take away $3 million of that, he said.
“There will have to be some tough decisions made,” he said.
That could mean cutting back on services or consolidating locations, he said.
But already the cuts have caused a nearly 10 percent reduction in the center’s staff. When the funding wasn’t renewed, Schalla said the center made the decision to eliminate 15 positions, most through attrition but the last few through layoffs, “because of not knowing what was going to happen.”
“We were able to do that,” he said. “But it definitely put our staff and our ability to serve our patients in our community the way we want to in a really precarious position.”
