Medicaid Expansion is a Boost for Health Centers, according to survey findings

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By Gaby Galvin, USNEWS Staff WriterApril 4, 2019, at 12:01 a.m.

Medicaid Expansion a Boost for Health CentersMore

A man arrives at the Community Health Center of NE Wetzel County March 22, 2017 in Burton, West Virginia.
The Republican-controlled House of Representatives votes Thursday on a key plank of Trump's legislative agenda -- his plan to repeal and replace Obamacare, his predecessor's crowning domestic policy achievement. / AFP PHOTO / Brendan Smialowski        (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)

Safety net clinics provide care for millions of people across the U.S.(BRENDAN SMIALOWSKI/AFP/GETTY IMAGES)

SAFETY NET HEALTH clinics have fared better in states that have expanded Medicaid coverage to more low-income residents than those in states that have not expanded the health program, according to a new survey.

Federally qualified health centers, along with “look-alike” clinics that lack the same grant funding, provide low-cost primary, behavioral health and dental care, serving millions of people – and 1 in 6 Medicaid patients – across the country. Federally qualified health center patients are more likely to suffer from chronic conditions, but the centers spend considerably less to care for patients than other providers.

The Affordable Care Act allocated $11 billion to operate and expand such community health centers over a five-year period. Since the law was enacted in 2010, millions of low-income people have obtained health coverage, in large part through the act’s push for states to expand Medicaid coverage. The survey and accompanying report from the Commonwealth Fundpoints to the increase in insured patients in particular as fueling the improved financial stability of community health centers – especially in states that expanded their Medicaid programs.

“The Affordable Care Act not only expanded health insurance coverage, but also helped usher in a variety of reforms in the way care is delivered,” Dr. David Blumenthal, president of the Commonwealth Fund, said in a statement.

The survey of nearly 700 health center officials found that since 2010, significantly greater shares of community health centers in Medicaid expansion states said they’d been able to more easily care for patients and expand their operations than health centers in non-expansion states.

For example, 76 percent of health centers in expansion states reported being better able to provide affordable care to more patients, compared with 52 percent of centers in non-expansion states. In expansion states, 62 percent of health centers said they saw improved funding for services and facility upgrades, compared with 46 percent in non-expansion states.

“While many factors other than Medicaid expansion likely influence these differences, the increased Medicaid revenue that health centers in expansion states receive may help them improve the way they deliver care,” the report says.

In expansion states, 87 percent of community health center patients were insured through Medicaid or the Children’s Health Insurance Program, compared with 58 percent of health center patients in non-expansion states, according to the report. Uninsured patients typically pay for services at these health centers on a sliding fee scale tied to income.

Improved insurance coverage in expansion states – and thus increased revenue to federally qualified health centers – “also may incentivize health centers to offer the behavioral health care and nonmedical services that a growing share of patients requires,” the report says.

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Health centers in Medicaid expansion states were more likely to offer counseling and behavioral health care, as well as to often provide medication-assisted treatment for opioid addiction. Those in expansion states also were more likely to coordinate with local social services organizations.

Yet expansion-state health centers were more likely to face shortages in staff to manage mental health and social services, the report found, calling such gaps “a potential barrier to meeting needs for behavioral health and social care.”

As the U.S. health care system, including Medicaid, continues to evolve, health experts say further integrating clinical care and efforts to address social determinants of health – such as access to transportation, affordable housing and healthy food – are key to improving population health, particularly for low-income patients who may face worse health outcomesand more barriers to health.

Federally qualified health centers also can be lifelines in medically underserved communities, including rural or poor areas. The Commonwealth Fund says policymakers should carefully consider the effects legislation has on community health centers and their patients, including the enactment of Medicaid work requirements that have been the subject of recent debate in states like Arkansas and Kentucky.

“Community health centers are an essential part of the way we deliver primary care in the United States,” Melinda Abrams, co-author of the report and vice president and director of health care delivery system reform at the Commonwealth Fund, said in a statement. “Their success spurs better results across the entire health care system.”

Gaby Galvin, Staff Writer

Gaby Galvin is a staff writer at U.S. News & World Report.

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