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Community health centers still in fiscal limbo

Dr. Barbara Hemenway of the Lake Superior Community Health Center does a stretching exercise with Gloria McDonald of Duluth to see what her range of movement is during an appointment Thursday morning at the center. Bob King / rking@duluthnews.com

John Lundy

Some of Minnesota's community health centers will start making cuts in early February if Congress hasn't resolved federal funding by then, advocates say.

"It's fairly doom and gloom," said Jonathan Watson, public policy director for the Minnesota Association of Community Health Centers. "I have a couple of health centers here in the Twin Cities that would be laying off at least 45 staff; another health center laying off about a third of their staff."

Community health centers act as a safety net, providing a variety of health services for uninsured or underinsured patients. Federal funding for the centers ran out in September, at the same time that funding ended for the Children's Health Insurance Program (CHIP). As part of the short-term fix that reopened the government on Monday, Congress reauthorized CHIP funding for the next six years. Community health center funding was left untouched.

The doom and gloom was partially forestalled in the Dec. 21 short-term budget fix, Watson said, when $550 million was authorized to cover federal funds for community health centers through the end of March.

That leaves health center administrators making plans for the potential of a shortfall soon.

The latest stopgap funding measure ends Feb. 8, and some community health center administrators are looking at that as a make-or-break date, Watson said.

"I know of at least two health centers that are saying, 'OK, if we don't have some sort of resolution by Feb. 8, (the next day) the plans get announced at the health centers, the layoffs and the scaling back."

The situation is less dire at the Lake Superior Community Health Center, which has clinics in Duluth and Superior. All community health centers rely on a mix of funding sources, but the Lake Superior center is one of the least dependent on federal funds in the nation, said Dayle Patterson, its CEO.

Although the funding loss still would be significant, the local health center has a little more flexibility than many other centers, she said.

"If we don't get any funding (in early February), but if we still have a high level of confidence that Congress will eventually act ... we'll plan to weather a short-term storm," Patterson said.

That would include minimizing non-essential spending and looking at not immediately filling open positions, she said.

If it appears Congress will never act, the approach would be to "grow revenue," Patterson said, by increasing services that are in demand, such as in oral health and behavioral health.

But other services, those that produce no revenue, might have to go by the wayside. An example is staff who help patients get to appointments, figure out how to get their prescriptions filled and how to connect with other resources in the community.

"There are things that we do, the bellwethers, the hallmarks of community health, that will become increasingly difficult to do," Patterson said.

Without federal funding, she thinks some community health centers would have to close, Patterson said, but "we're not looking at that."

If Congress doesn't act soon, the state might be looked upon to provide stopgap funding for Minnesota's community health centers, Watson said.

State Rep. Jennifer Schultz, DFL-Duluth, was in St. Paul earlier this week with the thought of doing just that.

"I decided to draft a bill and try to find emergency funds to continue funding ours in Minnesota and hopefully get a refund from the feds once they do agree to fund it," Schultz said.

She didn't yet know how much that would cost, Schultz said, but she noted that the state is expecting $400 million in additional revenue through the federal tax act "if they don't change it."

Her bill will be ready to go before the Legislature convenes on Feb. 20, she said.

"We just don't have time to wait," Schultz said. "I hope we can act on it the first day or second day of session."

Watson still is hopeful for federal action before then, he said. His sources tell him that, with CHIP funded, community health centers and opioid crisis funding are "next in the queue" for Sen. Mitch McConnell, R-Ky., the Senate majority leader.

"I'm not sure what 'next in the queue' exactly means," he said. "But I'm glad it's elevated to Sen. McConnell's radar screen that this needs to be fixed."

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