Community Health Centers: Part of the Safety Net

By Mary Beth Frideres, RN, Montana Primary Care Association

The “health care safety net” is a phrase you will hear more in the future. It is meant to describe services that are available to “catch” people in this country who are not able to use the traditional health care system and, therefore, “fall through the cracks.”

Most often, this is due to an individual’s financial situation, but it can also be due to not having health insurance, or not having enough or the right kind of health insurance, or even not speaking English.

Montana has its own assortment of safety net providers. One source of health care safety net services is Community Health Centers. These centers are growing and have the potential to grow even more to meet the needs of Montana’s underserved and vulnerable residents.

Montana Medicaid and community health centers in 14 Montana communities are partnering to improve the lives of people who receive health care through Medicaid.

In Montana in 2008, these health centers served more than 84,000 individuals, 52 percent of whom were uninsured (compared to 38 percent nationally). The population served by these health centers is predominately low-income. Nationally, 70 percent of the patients seen at health centers had family incomes less than 100 percent of the federal poverty level. This compares to 59 percent of health center patients seen in Montana.

Nationally, 39 percent of all health center patients are uninsured. In Montana, the proportion of uninsured is even higher: More 54.3 percent of health center patients seen in 2007 were uninsured. The percentage of Medicaid patients seen in Montana was half the proportion seen nationally, 14.3 percent versus 35 percent respectively. Patients with Medicare represented 9 percent of the Montana health center patient population, and private insurance patients accounted for 20.6 percent of the patient population. Although one in five patients has private insurance, national studies show that often private health insurance comes with high deductibles and cost sharing. Nationally, one-third of all health center patients were children and adolescents under 20 years of age. In Montana, children and adolescents accounted for 20 percent of the patient base. Considerably more adults (age 20-64) are served by health centers in Montana than in the nation, 71 percent versus 57 percent respectively. The proportion of the elderly (65+) served was similar throughout the nation at about 7 percent of the patient population.

Community Health Centers are private, not-for-profit, consumer-directed health care corporations that receive a federal grant under the U.S. Public Health Service Act. The centers provide comprehensive primary and preventive health care. This care is not free — clinic fees are based on the patient’s ability to pay. Primary care can be best defined as the type and scope of medical care that you receive from a family doctor.

Health centers typically have a staff of physicians, nurse practitioners, physician assistants, nurses, therapists, dentists and support workers. Services include primary-care visits, health education, disease screening, case management, laboratory services, dental care, pharmacy services, mental health and substance abuse counseling, and social services. Some offer evening and weekend hours for working families, provide care at multiple sites, use mobile clinics to serve hard-to-reach populations, and may employ multi-lingual staffs. All centers have a 24-hour system for after-hours calls and emergencies.

In 2002, Montana community health centers spent more than $17 million providing primary care services. The centers employed more than 257 fulltime jobs, and they provided over 176,700 medical, mental health/substance abuse, and/or dental services to 48,500 Montana residents (30,476 of whom were uninsured).

In Montana, 15 health centers received $472,225 in additional funding during 2008 to offset the rising cost of providing health care services. This award was part of $56.1 million made to centers nationwide.

Community health center funds flow from the federal government directly to Montana community boards that have policy-making authority and responsibility for the center’s management. At least 51 percent of a health center board must be comprised of patients who utilize the health center’s services. Such boards also include local business, civic, and community leaders and others who bring expertise and experience. Each board ensures that health center services are tailored to the unique needs of that community.

Currently, Montana health centers receive more than $8.5 million in federal grant dollars. These dollars are supplemented by health center revenue from Medicaid, Medicare, state and local government grants or contracts, private insurance payments, patient fees, foundation grants and private donations.

Most of the community health centers in Montana are independent entities, organized as 501(c)(3) not-for-profit corporations. Understanding that there will never be enough federal dollars to address all local health care needs, the federal Bureau of Primary Health Care developed the Community Health Center model around collaboration and partnership. Community health centers have close relationships with all public and non-profit health-related service providers in their area, as well as many private providers, and have developed cost-effective and resource-sharing approaches to address the needs of their patients. For example, hospitals and specialists in many areas provide discounted services to community health center patients. These partnerships, which focus on keeping community health center patients healthy and without need of hospitalization, reduce uncompensated, complex care.

“Community health centers in Montana have a long history of delivering excellent care management services,” said Department of Public Health and Human Services Director Anna Whiting Sorrell.

• — Gregg Davis of the Bureau of Business and Economic Research contributed to this report

Sidebar

In Montana, these clinics are funded under the U.S. Public Health Service Act.

There are nine community health centers in Montana:

Ashland Community Health Center, Ashland

Deering Community Health Center, Billings

Community Health Partners, Livingston (with a satellite clinic in Bozeman)

Community Health Center, Butte (with satellite clinics in Twin Bridges and Dillon)

Cooperative Health Center, Helena (with a satellite clinic in Lincoln)

Cascade Community Health Care Center, Great Falls

Sweet Medical Center, Chinook

Lincoln County Community Health Center, Libby

Partnership Health Center, Missoula

There is one migrant health program in Montana (Billings), with 10 clinic sites across the state. There is one Healthcare for the Homeless Program at Deering Community Health Center in Billings. The office has offices in Helena, Butte, and Missoula.