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Special Projects
Federal Program Helps Community Clinics Recoup Costs of Providing Care
 or clinics that provide health services to underserved Californians, keeping their doors open is often a struggle. Publicly funded programs like Medi-Cal reimburse clinics at rates that are far below actual costs of delivering health care. In some communities, local donors step in to help fill the gap; in others, however, the competition for those gifts is keen, and it is hard for organizations to be able to count on a consistent level of support.
As a result, community clinics throughout California have been assessing whether pursuing Federally Qualified Health Clinic (FQHC) status is a solution to their financial challenges. Under this program, which has seen major expansion by the Bush administration, clinics that meet program requirements negotiate a reimbursement rate from the government that more accurately reflects the actual costs of the services provided.
 For the staff at the Miners Family Health Center in the Sierra foothill community of Nevada City, pursuing FQHC status made sense. It would allow the clinic to expand its menu of services beyond primary health care to include behavioral health, preventive care, specialty services and radiology, and to plan for the addition of a dental clinic in 2006.
“With a patient population that is 65 percent Medi-Cal eligible, we were losing about $20 on each clinic visit,” said Robert Long, MFHC executive director. “We realized we needed to find a long-term solution because our community couldn’t readily make up this gap. It’s a guaranteed floor, so we know that we can make ends meet.”
The organization received a three-year, $120,000 TCWF grant to hire a consultant to prepare the extensive application and to pay for the expanded scope of required services during the application period.
The clinic started laying the groundwork for its application several years ago by securing its own nonprofit status, separate from the area physician’s group with whom it had been affiliated. It received its clinic license and underwent a financial audit. Its consultant also helped clinic staff develop many new protocols and procedures that were required by the government. The clinic learned in December 2004 that its application had been approved.
“The letter arrived on the 21st – it was a great Christmas present,” MFHC’s Long said.
FQHC status has already meant an improvement in the level of care available to low-income and underserved residents of Nevada County. The clinic has been able to take on some services traditionally provided by the county clinic, such as family planning and STD treatment. But at Miners Family Health Center, these patients are treated by a physician's assistant with training in family medicine who is able to address a broader range of their health needs and make appropriate referrals within the clinic.
“FQHC status will not be the right solution for every free or community clinic,” said Sandra Martínez, TCWF program director. “Yet for those that are able to meet the government’s requirements for services and operating standards, it opens up a new funding stream that can make it easier for clinics to expand and reach more of California’s currently underserved.”
| For more information, contact MFHC at (530) 265-7890. |
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