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Community Health Clinics Provide Critical Safety Net

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By Chris Levister –

A fight has broken out in San Bernardino, Fresno, Sacramento and other cities across California over how to spend millions of federal stimulus dollars earmarked for low- income community health centers known as Federally Qualified Health Centers (FQHC). Health providers are concerned that state policy makers are employing unfair tactics and gimmicks to use enhanced federal Medicaid matching funds from the “American Recovery and Reinvestment Act of 2009 to plug budget holes rather than strengthen critical health safety net services. Dr. Temetry Lindsey, President and CEO of Inland Behavioral and Health Services (IBHS) operates three (FQHCs) in San Bernardino County.

First Lady Michelle Obama announced the release of $850 million in stimulus grants in Washington, June 29, 2009. The funds are earmarked to help community health centers such as the Inland Behavioral and Health Services (IBHS) provide care to the most needy residents. IBHS officials say a fight has broken out over how California is using those federal grants to close budget gaps.In 2009 the not-for-profit received roughly $800,000 in stimulus money to expand low income health services in light of San Bernardino County’s soaring uninsured population.

The funds were allocated as a result of a 35% increase in uninsured patients in 2008. Lindsey says the stimulus money was earmarked to pay for a portion of that increased care and expand the center’s information technology capacity.

She said in the midst of the 2009 budget meltdown, lawmakers made deep cuts to state funded health programs and used accounting gimmicks and faulty one-time solutions which ended up costing IBHS $117,000 in lost revenue over a two year period.

“Where we received a dollar in federal stimulus money to expand services, California withheld two dollars in state funding. On one hand we are required to sustain current service and staffing levels. At the same time accepting the stimulus funds we are obligated to expand services.”

In what amounts to a temporary fix, Lindsey says IBHS was forced to elevate several part-time positions to full time.

“State funds intended to hire additional nurses, outreach workers and other staff were cut. We were able to hire an additional physician. In a nutshell, we’re upside down. Even with the stimulus funds we’re forced to do more with less.”

She said the state cuts cripple efforts to address a host of health problems community health centers can fight through preventive care. Lindsey says legal challenges and other stop actions taken by FQHCs nationwide have failed to gain traction.

“There’s a real concern over how much time, energy and money you should dedicate to fighting the elephant in the room.”

Last June First Lady Michelle Obama announced the release of $850 million in stimulus grants to centers such as IBHS. The stimulus law set aside about $2.5 billion for free and low-cost health clinics.

Two earlier sets of grants awarded just under $500 million to FQHCs.

A report by the Legislative Analyst’s Office stated that the Governor’s proposed 2010 reductions to the Expanded Access to Primary Care program, Medi-Cal and other key clinic programs will further limit access to state funded primary and preventative health care, and create new barriers for the thousands of low income individuals that count on these programs.

Three Federally Qualified Health Centers (FQHCs)in San Bernardino County provide free and low cost health and dental services to the region's most vulnerable populations.California once again will look under sofa cushions and scour every sector of state government to find another $20.7 billion to balance its budget over the next 19 months. The governor has to present his spending plan for the 2010-11 fiscal year to the Legislature by January 10, and is likely to include more deep cuts to health care, education and prisons.

“We’re bracing for more cuts,” said Lindsey.

Lawmakers will have to cut just about every area of government –except for a couple. The state accepted federal stimulus funds for education and Medi-Cal, so the state can’t cut those programs.

That means cuts to other programs will be much deeper.

In late March 2009 Schwarzenegger signed a bill to change eligibility requirements for Medi-Cal, the state’s Medicaid program. Those changes allowed the state to receive more than $10 billion in federal stimulus funding.

However in May the Centers for Medicare and Medicaid ruled that action violated home healthcare workers compensation requirements. The legislature was ordered to rescind the cuts or lose $6.8 billion in stimulus funding.

“It’s been well documented that San Bernardino County is an area of immense need with fewer health resources than the rest of the state,” said Lindsey.

In spite of the evidence on the important role community clinics play medically, economically and socially in serving the area’s most vulnerable population Lindsey says, Governor Schwarzenegger’s latest budget recommendations ignore the devastating impact on the ability of FQHCs to continue to provide a health care safety net.


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