Rebecca Morris, Jessica Sharac, Sara Rosenbaum, Feygele Jacobs, Peter Shin
Approximately 6.2 million uninsured patients at community health centers could be hit with COVID-19 testing, vaccination, and treatment costs beginning tomorrow, April 5th, as the COVID-19 uninsured fund expires. Since 1 in 5 patients at centers are uninsured, the financial burden on centers could be substantial. In the first year of the pandemic, health center self-pay revenue (which includes both payments for uninsured patients as well as cost-sharing responsibilities for insured patients) decreased by 10 percent, from $1.38 billion in 2019 to $1.24 billion in 2020. During this same time frame, other public insurance revenue increased by 15 percent, with most of the revenue growth attributable to $50 million paid to health centers through the COVID-19 Uninsured Program. Modern Healthcare explains that community health centers may need to cut staffing and hours in response to the anticipated lost payments for COVID-19 testing and treatment. The timing is especially poor since the FDA recently authorized a second booster vaccine dose for older adults and individuals with immunocompromised conditions.
There are numerous potential health implications for the community health center patient population. The pandemic has already exacerbated existing health disparities. There is substantial evidence that low-wage workers and minorities are at increased risk for harm from COVID-19, so the coverage of COVID-19 vaccination, testing, and treatment is particularly important for these groups. Health centers tested 15 million patients for the COVID-19 virus between April 2020 and December 2021, and racial/ethnic minorities have been disproportionately likely to test positive.
Putting additional financial constraints on community health centers likely would further harm the vulnerable populations that health centers disproportionately serve. As we saw earlier in the pandemic, the spillover effects from delayed/missed care for other types of services could be significant. Between 2019 and 2020, the number of community health center visits for substance use disorder services decreased by 9 percent, though rates of mental health issues and substance use disorders have been increasing due to the pandemic. Dental services visits at health centers decreased by 34 percent from 2019 to 2020. Moreover, there has been significant unmet need for food, housing, and employment during the pandemic, which community health centers are already straining to address.
Medicaid does not fully cover the costs for needed health services for the low-income patients that centers–in 2020, even with increased federal Medicaid financing due to the COVID-19 public health emergency, only 83 percent of Medicaid charges at health centers were collected. fOnly 15 states have elected to use Medicaid to finance COVID-19 services for uninsured patients, and this option will expire with the public health emergency. The impact of the loss of coverage for COVID-19 vaccination, testing, and treatment will further be exacerbated as the Medicaid wind down takes place, and states redetermine member eligibility. The Urban Institute estimated that 15 million people could lose Medicaid coverage in 2022. Approximately half of community health center patients use Medicaid. As patients become uninsured, the squeeze on community health center budgets will tighten if centers must write off higher proportions of service costs. Even among individuals who retain Medicaid, protections against cost-sharing will expire a year after the public health emergency ends, and a number of other state-specific emergency actions will end.
This financial hit to community health centers and the resulting health consequences for patients are avoidable. The removal of numerous protections for low-income people in need of health services will shift the cost burden to safety net providers. Community health centers, as front-line providers of COVID-19 services and other essential health services for vulnerable populations, will disproportionately bear the brunt of these costs. The development of a plan that will provide protection for community health centers, and other safety net providers, as pandemic-related policies end is a necessity for the health of low-income communities across the country.