Traditional Clinic Programs

OVERVIEW

Community clinics and health centers (CCHC) play a critical role in assuring access to health care for Californians, especially those who are uninsured or who experience other barriers to care. California is home to 6.6 million uninsured—the largest number in any U.S. state and 15 percent of the country’s total uninsured. 1 Nearly one in every five Californians has no health insurance. 2 This number is likely to increase dramatically with the state and national economic crisis. In 2009 California lost over 600,000 jobs, 3 and with this loss of employment will follow a loss of employer-sponsored healthcare coverage. The lack of health coverage impacts not just the individual but the entire society. A recent Families USA study, determined that the cost of all the uninsured nationally adds an additional $368 to health coverage provided to a single individual. 4 And compounding these access barriers are the increasing costs of healthcare for individuals with coverage. One study reports that nearly 30 percent of people say someone in their family with health insurance delayed care because of cost.5 Were it not for CCHCs, the cost of health care coverage would escalate as the only option for care for the uninsured would be the emergency room.

CCHCs are vitally important as a medical home to a significant portion of the state’s population. A statewide network of nearly 800 clinic sites provides a great portion of care to the uninsured. In 2007, CCHCs delivered more than 12 million encounters to over 4 million patients.

Nearly two-thirds of clinic patients have incomes below the federal poverty line; 83 percent live below 200 percent of poverty. 7 CCHCs offer a comprehensive continuum of care to all Californians, regardless of their ability to pay. In some communities, CCHCs are the only providers available to low-income residents who are uninsured or are on Medi-Cal.

The State of California has long acknowledged the important role CCHCs play in securing the safety net. The traditional clinic programs, as CPCA refers to them, have provided additional funds to CCHCs to assist them in their delivery of care to the uninsured, rural residents, migrant and seasonal farmworkers, and American Indians. The four programs include: Expanded Access to Primary Care (EAPC), Rural Health Services Development (RHSD), Seasonal Agricultural Migratory Worker (SAMW), and Indian Health Program (IHP).

  1. U.S. Census Bureau, 2005 and 2006 Current Population Survey, April 2006 release.
  2. California HealthCare Foundation. Snapshot: California’s Uninsured 2006. (Data is from the Employee Benefit Research Institute’s analysis of the Current Population Survey).
  3. California Department of Finance, Finance Bulletin, April 2009.
  4. Families USA (2009). Hidden Health Tax: Americans Pay a Premium.
  5. National Coalition on Health Care, Cost Fact Sheet, Accessed December 12, 2008. http://www.nchc.org/documents/cost_fact_sheet_2008.pdf
  6. California Office of Statewide Health Planning and Development (OSHPD), 2007.
  7. OSHPD, 2007.

CURRENT ADVOCACY

In July 2009, the Governor blue penciled(line item vetoed) the traditional clinic programs taking all $35.1 million in General Fund contributions from Expanded Access to Primary Care (EAPC), Rural Health Services Development (RHSD), Seasonal Agricultural Migratory Worker (SAMW), and Indian Health Program (IHP). This elimination has deeply impacted all clinics, from the largest in urban centers to the smallest in frontier counties.

From their inception, the traditional clinic programs have been a much needed source of funding to help offset the costs of the uninsured services clinics are mandated to provide. In 2008, these programs helped provide compensation for 1.8 million uninsured patient visits. This is in addition to 2.5 million uninsured visits where there was no additional compensation. Now, California’s CCHCs are tasked with finding the resources to pay for 4.3 million uncompensated patient visits.

The Governor tried to justify his actions by stating that “many, if not all, of these clinics will continue to receive funding from Medi-Cal and other state programs and federal funds, local grants and private funds.” He went further to say that “many of these clinics are also receiving federal stimulus funds which will help soften the impact of this necessary reduction.” From these statements, it is clear that the Governor does not fully appreciate the cost of the service CCHCs provide to California or the federal government’s intent of the Increased Demand for Services (IDS) funding. CCHCs cannot continue to provide a cost savings to the state if the Governor eliminates and substantially reduces the very programs that comprise the health care safety net funding. Further, the IDS funding was meant to assist federally qualified health centers and rural health clinics manage and care for the INCREASE in their uninsured patient populations, which in some cases is as high as 50 percent, not backfill what the state planned to eliminate. It is important to note that non-FQHCs/RHCs have not received any federal stimulus funding.

It is a main priority for CPCA to ensure the traditional clinic programs are refunded.

RESOURCES

The following are District Profiles of the 10 Conference Committee Members' Districts highlighting Federal Stimulus "Increased Demand for Services" (ARRA) funding. These were utilized during the 2009 budget negotiations.

The following two documents are a compilation of the impact of the elimination of the programs by both Assembly and Senate District based on 2007 data.

Additionally, CPCA has created three white papers as educational material on three of the traditional clinic programs.

ANNOUNCEMENTS

None at this time.

CPCA STAFF CONTACT

If you have any questions, or need more information, please contact Andie Patterson, Deputy Director of Regulatory Affairs, at apatterson@cpca.org.




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