LEWISTON — Community health centers in Maine are bracing for a funding crash that could lead them to lay off workers and stop providing some medical care.
Federally qualified health centers are approved by the government to provide health care to the under-served — often those in rural communities, poor families and people without insurance. In return, those health centers receive federal money in addition to any payments they get from private insurance, Medicaid, Medicare or patients who pay cash.
There are 70 federally qualified health center sites scattered across Maine, including several in Androscoggin, Oxford and Franklin counties. Together they serve 210,000 patients, or about one in six Mainers.
Although the health centers have been popular among both Democrats and Republicans, the special fund earmarked for the centers expired this fall and has not yet been reauthorized. That money accounts for about 70 percent of health centers’ federal funding.
Advocates had hoped that money would be included in a continuing resolution designed to fund the government for a short time and avoid a shutdown Friday. But there has been little agreement about a federal budget and President Donald Trump said this week that a government shutdown could happen Saturday.
That leaves health centers with funding that will soon run out.
“It just starts to feel pretty heavy when you get this far out and there’s not a resolution,” said Darcy Shargo, interim CEO for the Maine Primary Care Association.
Health centers will each be paid through the end of their current grant periods. After that, the federal Health Resources and Services Administration has said it will pay centers month to month, but there’s no guarantee how much centers will get then. It’s also unclear how long the agency can keep up those payments, since it will use money from other accounts until those funds are depleted.
Some centers’ grants end in January or February. Others have grant periods that end well into 2018, but the uncertainty has them cutting back now.
DFD Russell Medical Centers is an independent, nonprofit group that runs health centers in Leeds, Monmouth and Turner and has 8,000 to 10,000 active patients.
Its grant funding ends March 31. It stands to lose more than $1 million of its nearly $6 million budget.
CEO Laurie Kane-Lewis said continuing to operate without that money “would be extremely difficult.”
DFD Russell has already instituted a hiring freeze and Kane-Lewis is looking at ways to save money on employee health insurance. Without that federal funding, the Monmouth health center would halt a new medication-assisted therapy program it had planned to start in January to help people battling drug addiction.
Kane-Lewis is also considering closing down one of her three health centers to consolidate services, “at the very least,” she said.
DFD Russell has enough cash on hand to put off major changes, such as consolidation, for about six months, but not everyone is that financially secure.
“Other health centers are in precarious situations,” Kane-Lewis said.
According to the Maine Primary Care Association, at least 25 health centers are looking at closing and nearly 400 employees are facing layoffs. It believes nearly 30,000 patients could lose health care, including access to their primary care doctor, counselor, dentist or substance abuse program.
Because they’re typically poor and uninsured, those patients would either have to go without medical care or travel to another community health center — if that center is close enough and can take new patients.
The B Street Health Center in Lewiston serves 15,000 patients a year as a look-alike center, which means it performs the duties of a federally qualified center, but it does not receive the same funding, so it isn’t facing the same financial problem. But it can’t replace all of the other health centers if they close.
“If we were the last one standing, who knows what would happen?” said Executive Director Joan Churchill. “To the extent that people could come to us for services, we would be trying to help them.”
Advocates hope, at least, to be included in a federal budget’s continuing resolution so health centers can be paid for a little while longer, just until lawmakers pass a bill reauthorizing funding. Ultimately, they’d like a permanent solution so they won’t have to go through this again.
“When you go to a place like a health center, many of them tend to be the only game in town or the only game that really provides a sliding fee and is open to everyone regardless of ability to pay,” Shargo said.
“Even if the health center itself weren’t closed, I think just sort of this cloud of uncertainty creates perceptions in communities that may make people think twice before they go see a doctor,” she said. “And we certainly don’t want that.”