Federal money for community health centers in Connecticut and across the nation remains in limbo, causing center officials to create contingency plans that include layoffs and cuts to services.
Despite broad bipartisan support, Congress missed its Sept. 30 deadline to reauthorize money for the Community Health Center Fund, which represents the largest chunk of federal funds going to the centers. The fund provided health centers nationwide with $3.6 billion in each of the previous two years. It was created in 2010 as part of the Affordable Care Act and was last extended in 2015.
Community health centers also have received money through the annual federal budget — $1.5 billion last year — and that remains unresolved because Congress hasn’t passed a budget for the current fiscal year.
After months of uncertainty, community health center executives have found it hard to plan for the future. In Connecticut, some have implemented hiring freezes and others have been unable to restructure loan payments. They have developed contingency plans including deep cuts to staff and services in case the federal money is never approved.
“It’s an unfortunate result of the inability of Congress to work together even on issues that they agree on,” said Deb Polun, senior director of policy and outreach at the Community Health Center Association of Connecticut. “Our congressional delegation here in Connecticut has been extremely supportive of community health centers for many years.”
Sixteen centers in Connecticut have received about $58 million from the federal government in the 2016-17 fiscal year — $41 million of which came from the Community Health Center Fund.
In 2016, over 376,000 patients in Connecticut received their care at community health centers. About 63 percent were on Medicaid and 16 percent were uninsured. All centers offer a sliding scale of charges for uninsured and low-income patients, according to the health center association.
“They really are the backbone of delivering primary care,” said U.S. Rep. Joe Courtney, D-2nd District.
Courtney, a longtime supporter of the health centers, said that Congress’s inaction is “another example of how Washington is really disconnected from what the rest of the country considers urgent problems.”
Health centers in Connecticut have varying grant cycles, with two centers expecting federal grants in January — Charter Oak Health Center in Hartford and Generations Family Health Center in Willimantic. The rest have grant cycles that begin in February, March, April, May or June.
Lawmakers in the U.S. House have introduced several proposals that extend the Community Health Center Fund over the next few years, including one in a continuing resolution that would fund the federal government temporarily. A budget or continuing resolution must be passed by the end of the week to avoid a partial shutdown of the government.
“I am hopeful but I’m not optimistic, but I do feel that they probably will push this off to January,” Polun said. “Then hopefully with a new year in front of them, they will be able to get it done as soon as possible.”
Those health centers with grant cycles that begin in January and February will receive money from the federal Health Resources and Services Administration (HRSA), regardless of what Congress decides.
According to a statement from HRSA, the agency is processing two-month prorated awards for health centers with grants that start on Jan. 1, and one-month prorated awards for health centers with grants that start on Feb. 1.
The Jan. 1 payments already have gone out, and Feb. 1 payments will be sent out soon. HRSA plans to continue providing month-to-month continuation awards using discretionary appropriations and any remaining money from the Community Health Center Fund until that money is gone, according to the statement.
HRSA also said that President Donald Trump’s 2018 fiscal year budget request includes $3.6 billion for the Community Health Center Fund in each of the 2018 and 2019 fiscal years.
Congress also failed to reauthorize two other related programs, the National Health Service Corps (NHSC), which offers scholarships and loan repayment to primary care providers and students for serving at NHSC sites in communities with limited access to health care; and Teaching Health Centers, which train medical residents to work as primary care doctors at community health centers and similar sites.
Connecticut has one Teaching Health Center — Greater Danbury Community Health Center in Danbury.
“These programs are critical recruitment tools, particularly the National Health Service Corps,” Polun said.
Possible cuts to staff and services
Nichelle Mullins, president and CEO of Charter Oak Health Center, said management would have to cut 30 to 40 full-time positions, mainly in administrative and patient-support roles, if the center doesn’t receive its grant from the Community Health Center Fund.
Charter Oak has two sites in Hartford and has received about $4 million from the fund in 2017.
“Medical, dental, behavioral health treatment would be jeopardized for all of our 19,000 patients that we serve on an annual basis through almost 90,000 visits,” Mullins said in a statement.
Generations Family Health Center’s multiple sites in rural northeastern Connecticut serve about 22,500 patients each year. In 2017, the health center received about $2.7 million from the fund.
CEO Arvind Shaw said the center has frozen hiring. In a worst-case scenario, Shaw said, health center management would have to make hard decisions that would affect their ability to serve patients, including laying off staff and cutting services.
But he predicted that Congress will approve the money.
“I see this as being a temporary mistake, and it will be fixed,” he said. “Alternatively, patients will seek primary care from the ER or will go without being treated.”
U.S. Sen. Chris Murphy, D-Conn., advocated for the community health center funding during a speech on the Senate floor Tuesday.
“In rural America, the slashing of community health center funding will be absolutely devastating, because it is sometimes these community health centers that are the only way for some people to get care, particularly mental health care and addiction care,” Murphy said.