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Health Centers Serving Low-Income Communities Decimated By COVID-19 Say Cuomo Is Starving Them Of Vital Funding
By
Caroline Lewis
Published Apr 8, 2020
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Mike Groll/Office of Governor Andrew M. Cuomo
By
Caroline Lewis
Published Apr 8, 2020
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With the city’s emergency medical services and hospitals overwhelmed by coronavirus patients, the FDNY recently asked non-hospital health care providers to help alleviate some of the pressure by fielding 911 calls from people who don’t require emergency care. Community Healthcare Network (CHN), which operates clinics serving low-income New Yorkers throughout the city, stepped up, even though the role wouldn’t come with any new funding.
“The chief medical officer at the Fire Department has a good sense of humor and said they would pay us with one-day vouchers for Disneyland,” recalled Robert Hayes, president and CEO of CHN. “As with everything else we do, we’re going to lose money.”
In addition to assisting with emerging needs related to the coronavirus, CHN and other community health centers continue to offer regular health care during the pandemic—mostly via phone or video chat but also in person for those who need it.
With patient visits down and telehealth services garnering lower payment rates than in-person care, these vital safety-net institutions say they are hemorrhaging money. They worry that without adequate government support they will be gutted by the time New York makes it to the other side.
“It’s dismal,” said Hayes, who projects CHN will lose $18 million between now and July. “Our financial stability is deteriorating hour by hour.”
Community health centers tend to serve the populations currently being hit hardest by the novel coronavirus. About 62 percent of their patients are black or Latinx and 29 percent speak limited English. These health care providers often go beyond the typical care offered at a doctor's office to help people manage chronic conditions. Services can include things like nutritional coaching for people with diabetes or check-ins to make sure people who struggle to take their medication are taking it everyday.
The loss of revenue is partially unavoidable: people are being encouraged to forego non-essential, in-person health care visits. New York’s community health centers (formally known as Federally Qualified Health Centers) have averaged a 56 percent drop in patient visits since the pandemic hit the city, and about half have laid off or furloughed staff, according to recent surveys conducted by the Community Health Care Association of New York State (CHCANYS), which represents 74 community health centers statewide. Telehealth services provided via phone or video chat only make up for a fraction of that lost patient volume.
But community health center leaders say the financial stability of their institutions is being further eroded by insufficient reimbursement for those telehealth services.
Even as Governor Andrew Cuomo encourages the use of telemedicine as a means of preventing the spread of COVID-19, the state Department of Health has made it clear that Medicaid will not guarantee the same reimbursement for remote services as it does for in-person care. In some cases, health centers say they risk providing services without getting reimbursed at all.
Under federal law, the state is supposed to ensure that community health centers receive a minimum standard rate for each patient visit. If a particular health plan does not pay the minimum amount, the state is responsible for making up the difference. This is known as the wrap payment. But DOH said in guidance issued last week that community health centers will not receive a wrap payment for telemedicine visits—which are already being reimbursed at a lower rate—because they don’t come with “the full cost of clinic care.”
“So if a health plan pays $10, that’s all you’re getting,” explained Lacey Clarke, vice president of policy at CHCANYS. “And if a health plan doesn’t pay [for certain telehealth services] at all, then you don’t get any money for those visits. It’s already a problem to have a low rate and then DOH says, ‘Sorry, we’re not going to guarantee you get any rate at all.’”
Clarke says another aspect of DOH’s guidance has created a technical issue that prevents community health centers from billing for telehealth services provided by certain types of staff. This includes social workers, who often provide therapy for people in need of mental health care.
“One of the easiest kinds of health care to provide telephonically is behavioral health and therapy,” said Hayes. “We have 15 therapists working very hard to take care of existing patients and to take on new patients. We’re not getting paid a penny for that.”
DOH did not respond to a question about whether this was intentional.
“We take the needs of New York State’s healthcare providers, including community health centers, very seriously and we are working with them to ensure that our guidance is reflective of their challenges and needs based on these unprecedented circumstances,” a DOH spokesman said in a statement, declining to answer specific questions about Medicaid reimbursement for telehealth.
Members of CHCANYS are considering legal action against the state to restore guaranteed payments for their services.
Federal stimulus packages for coronavirus provide limited relief. So far, just under $3 million in federal funding has been allocated to community health centers in New York City and Long Island. Most are receiving under $100,000 each, despite projected losses of millions of dollars.
“This funding puts critical dollars in the hands of health centers and professionals who risk their lives and health every day during this crisis,” said Senator Chuck Schumer. "I have fought tooth and nail to get New York’s health workers the federal funding they need to beat back this pandemic, and I will do whatever it takes in the coming weeks to keep the support flowing.”
More funding may be forthcoming. The CARES Act includes an additional $1.3 billion for community health centers nationwide, although it’s not yet clear how that funding will be allocated.
One of the local organizations that has been impacted is Housing Works, which provides a wide range of services for people with HIV and other chronic conditions, including operating community health centers. The organization projects a shortfall of $8.5 million between March and the end of June.
“We’ve tried to prune thoughtfully,” said Charles King, CEO of Housing Works, “but have had to furlough people or do layoffs throughout the organization.” Most of the laid off staff have been retail workers at the temporarily shuttered Housing Works thrift stores and bookstore/cafe, which help bring in revenue for the nonprofit’s other operations. But King says some clinical staff have been let go as well.
Some laid off employees are being offered opportunities to take on new roles amid the coronavirus outbreak, albeit in a more dangerous environment. Housing Works is contracting with the city’s Department of Homeless Services to open an isolation shelter for homeless New Yorkers who have tested positive for coronavirus or have symptoms and cannot safely stay in congregate shelters. Callen-Lorde Community Health Center is in talks about providing clinical services at the shelter while Housing Works seeks to recruit non-clinical staff.
“Asking people who have been laid off if they want to collect unemployment or go work in a place serving people with COVID-19, it hasn’t been the easiest sell,” King said.
Notably, when the coronavirus outbreak hit New York, Housing Works staff were already pushing to form a union. Because King has declined to voluntarily recognize the union, the staff must conduct a vote through the National Labor Relations Board. The NLRB resumed elections for union representation this week after they were temporarily suspended amid the pandemic.
Despite lost revenue and precarious conditions, community health centers say they will continue to try to serve patients and the city in any way they can.
“Our role in this crisis is to support the entire public health infrastructure by keeping people out of the hospital,” said Wendy Stark, executive director of Callen-Lorde, which primarily serves low-income LGBTQ patients. “So many of our patients live with chronic diseases like HIV and diabetes and will need to see a doctor at this time. The worst thing we could do is have patients go to the hospital for something that could be handled in the community.”
As part of our health cost transparency project #PriceCheckNYC, Gothamist, WNYC and ClearHealthCosts are tracking health care coverage and access amid the coronavirus outbreak. Community health centers aren’t the only ones being impacted. If you are a health care provider struggling to get adequately reimbursed for telehealth services or a patient whose insurance is denying coverage for telehealth, please tell us about it at [email protected].
As usual you can submit recent health care bills, including those not related to coronavirus, to our interactive database below.
Tagged
COVID-19
pricechecknyc
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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