Welfare health centers cut services and staff as Medicaid is ‘winded down’ – The Mercury News

One of Montana's largest health clinics serving people in poverty has cut services and laid off employees. The layoffs are just like similar cuts across the country as health centers that provide social security feel the impact of federal cuts to Medicaid.

Billings-based RiverStone Health is cutting 42 jobs this spring, or nearly 10% of its workforce. As a part of the cuts, it has closed an inpatient hospice facility, closed a middle for patients with hypertension and laid off a nurse who worked in rural schools. It also downsized the clinic's mental health team and reduced the variety of staff focused on caring for the homeless.

RiverStone Health CEO Jon Forte said hospital officials had expected a deficit as operating costs have risen lately. But a $3.2 million revenue loss, which he attributed largely to Montana authorities disenrolling large numbers of patients from Medicaid, pushed RiverStone's deficit even further into the red than expected.

“It put us in a hole we couldn’t get out of,” Forte said.

RiverStone is certainly one of almost 1,400 publicly funded clinics within the United States that adjust their fees based on patients' ability to pay. They are designed to succeed in individuals who face disproportionate barriers to care. Some are situated in rural communities where providing basic care might be financially draining. Others give attention to vulnerable populations who fall through the cracks in urban centers. Collectively, these clinics serve greater than 30 million people.

The lifeblood of health centers is revenue from Medicaid, the government-subsidized medical health insurance program for individuals with low incomes or disabilities. Because they serve a bigger share of low-income people, the government-funded centers are inclined to have a bigger share of patients in this system and depend on these reimbursements.

But Medicaid enrollment is undergoing a radical shift as states reevaluate who’s eligible. This process known as “Medicaid wind-down.” It follows a two-year ban on opt-outs that ensured people's access to health care through the Covid health emergency.

From 23 May greater than 22 million People had lost their coverage, including about 134,000 in Montana – 12% of the state's population. Some not met income requirements, however the overwhelming majority were kicked out due to paperwork problems, equivalent to missing a deadline, government documents going to outdated addresses or system errors.

That means health centers are increasingly offering uncompensated care. Some have seen a drop in patient numbers, which suggests less money. When providers like RiverStone in the reduction of on services, vulnerable patients have fewer treatment options.

Jon Ebelt, communications director for the Montana Department of Health and Human Services, said the agency is just not chargeable for the business decisions of individual organizations. He said the state is concentrated on maintaining social security systems while protecting Medicaid from abuse.

Across the country, health centers are facing the same problem: an ideal financial storm brought on by a pointy rise in treatment costs, a shortage of staff and now fewer insured patients. In recent months, clinics in California and Colorado have also announced cuts.

“It’s happening in every corner of the country,” said Amanda Pears Kelly, CEO of Advocates for Community Health, a national advocacy group that represents federally qualified health centers.

Nearly 1 / 4 of the community health facility's patients who depend on Medicaid have been excluded from this system. in response to a joint survey from George Washington University and the National Association of Community Health Centers. On average, each center lost about $600,000.

In one in ten centers, either staff or services were reduced or the variety of appointments was restricted.

“Health centers of all kinds are trying to make sure patients know they are still there,” said Joe Dunn, senior vp of public policy and advocacy on the National Association of Community Health Centers.

Most centres are operating on very tight budgets and a few have experienced losses as a result of staff reductions and rapidly increasing operating costs.

Meanwhile, federal grants – money designed to cover costs for individuals who can't afford treatment – remained largely unchanged. Congress increased those funds in March to about $7 billion for 15 months, though health facility advocates said that was still not enough.

Until recently, RiverStone in Montana was financially stable. Before the pandemic, the organization was earning profits, in response to financial audits.

In the summer of 2019, a $10 million expansion began to repay. RiverStone served more patients through its clinic and pharmacy, a rise in revenue that greater than offset the rise in operating costs, documents show.

But in 2021, at the peak of the pandemic, those rising expenses – staff salaries, constructing maintenance, drug and medical equipment prices – exceeded revenue. Last summer, the corporate had an operating lack of about $1.7 million. With Medicaid insurance repricing, RiverStone's pool of insured patients shrank, eroding its financial buffer.

Forte said the health facility plans to ask state authorities to extend Medicaid reimbursement rates because existing rates don’t cover all care. That is a sensitive request after the state increased its prices Last yr, the quantity fell barely after an extended debate about which services needed extra money.

Some of the cuts at health centers represent a return to pre-pandemic staffing levels after temporary federal pandemic funding dried up, while others are scaling back longstanding programs as budgets have gone from tight budgets to the red.

California's Petaluma Health Center laid off 32 employees in March who had been hired through the pandemic. The Press Democrat or about 5% of the workforce. It is certainly one of the biggest primary care providers in Sonoma County, where life expectancy varies is determined by where people live. Poverty is more prevalent in predominantly Hispanic neighborhoods.

Clinica Family Health, which operates clinics across Colorado's Front Range, laid off 46 employees, or about 8 percent of its workforce, in October. The company reduced its dental program from three clinics to 2, closed a walk-in clinic designed to save lots of patients a visit to the emergency room and ended a house visit program for patients recently discharged from the hospital.

Clinica said 37% of patients who were covered by Medicaid before the settlement lost their coverage and at the moment are in Clinica's rebate program, meaning the clinic now receives between $5 and $25 for office visits that used to herald $220 to $230.

“If it's a game of musical chairs, we're the ones with the last chair. And if we have to pull it away, people fall to the floor,” said CEO Simon Smith.

Stephanie Brooks, policy director for the Colorado Community Health Network, which represents Colorado's health centers, said some centers are considering consolidating or closing clinics.

Colorado and Montana are among the many nation's highest percentages of enrollment declinesOfficials in each states have defended their process for re-evaluating Medicaid coverage, saying most individuals whose coverage was cut are likely not eligible, citing low unemployment rates as one factor.

In many states, each health care providers and patients have provided examples of people that had their medical health insurance revoked but were still eligible for it becoming entangled in system problems for months simply to regain access.

RiverStone's Forte said reducing services within the wake of a pandemic makes things worse – each for health care employees who stayed of their tough jobs and for patients who’ve lost confidence that they will access care.

“This is so counterproductive and counterintuitive to our commitment to providing health care to our community,” Forte said.


KFF Health News correspondent Rae Ellen Bichell in Longmont, Colorado, contributed to this report.

(KFF Health News is a national newsroom that produces in-depth journalism on health issues and is certainly one of the core programs of KFF – the independent source for health policy research, polls and journalism.)

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