Funds at risk for community health centers

Karen Bouffard
The Detroit News

Federally funded community health centers, a major source of doctors in Michigan's urban and rural communities, will lose up to 70 percent of their funding in September if Congress doesn't grant an extension.

Michigan has 35 "federally qualified" health centers providing medical care at roughly 240 clinic sites across the state — mostly rural outposts and urban neighborhoods with high levels of poverty and a scarcity of primary care physicians. Wayne, Oakland and Macomb counties have 13 such centers, providing health care at nearly 50 locations.

The clinics provide access to care for many new patients in Healthy Michigan, the state's expanded Medicaid program that has enrolled about a half-million Michiganians since it started in April. Nationwide, the centers are a key part of efforts to expand access to health care under the federal Affordable Care Act.

"Michigan's community health centers serve nearly 700,000 people, and the funding cliff puts many Michigan families at risk of losing access to their physicians, nurse practitioners, dentists and other health providers," said Kim Sibilsky, CEO of the Michigan Primary Care Association. "This puts their health at risk, but also the health of the communities in which they live and work."

The issue seems to resonate with some of Michigan's congressional delegation.

U.S. Rep. John Conyers, D-Detroit, visited the Thea Bowman Community Health Center this month to draw attention to the September funding deadline. The office of U.S. Rep. Fred Upton said the St. Joseph Republican, who chairs the House Energy and Commerce Committee, is working on the issue.

"Congressman Upton understands the importance of federally qualified health centers and is reviewing the authorization and meeting with stakeholders to determine the best path forward," Upton spokesman Tom Wilbur said.

U.S. Rep. Sander Levin, the delegation's senior Democrat from Royal Oak, said health center aid is one of several health-funding issues Congress needs to address, including money for the State Children's Health Insurance Program that is due to expire on Sept. 30. CHIP enrollment totaled 8.4 million children in 2013, including nearly 90,000 children in Michigan.

"We have some critical decisions to be made," Levin said.

Health centers save about $24 billion in national health care spending by helping patients avoid emergency rooms and make better use of preventive services, according to the Michigan Primary Care Association.

About 23 million Americans rely on the centers, which provide primary care, pediatric services, vaccinations, mental health and substance abuse treatment, and dental care. They also get money from other sources.

Thousands face losing care

Eight health centers are in Detroit, which operate about 30 clinics throughout the city. The centers accept health insurance and Medicaid coverage for low-income residents, and provide free health care for the homeless and uninsured.

The plunge in federal funding would affect Advantage Health Centers, which operates four Detroit clinics.

"It could mean the difference between serving 25,000 people and having that cut down to 15,000 or 16,000," said Melissa DaSilva, director of operations at Advantage Health Centers.

Michelle Harvey, 44, of Southfield, recently visited the Thea Bowman Community Health Center, an Advantage Health Centers clinic on McNichols in west Detroit. She makes $8.15 an hour working for a temp agency, has no benefits and recently was diagnosed with a thyroid condition.

Harvey's income is too low to qualify for insurance in the federal Health Insurance Marketplace, so a social worker at Advantage is helping her enroll in the Healthy Michigan Plan.

"If this place wasn't here, I would not be able to get treatment for the hyperthyroid that I have," Harvey said.

Scores of health center officials from across the country are converging on Washington, D.C., to raise the funding issue with lawmakers. In a February letter to members, Dan Hawkins, vice president of policy and research for the organization, urged members to reach out to lawmakers, saying countless meetings with members of Congress had convinced him that "fixing the funding cliff is not a priority for many members of Congress."

Millions in funding at stake

Donald Simila is among Michigan health advocates in Washington, D.C., this week. He's the CEO of Upper Great Lakes Family Health Center based in Hancock, in Michigan's Upper Peninsula.

Upper Great Lakes' patient base has exploded in the past year and a half, jumping from 4,000 patients to 26,000 patients as previously uninsured residents enrolled in Medicaid or purchased low-cost policies at

"(We) have 11 clinics at nine sites covering five counties of the Upper Peninsula," said Elise Bur, administrative director of Upper Great Lakes. "If we lose 70 percent of our funding, that's $1.2 million of grant funding we would lose."

Losing that much funding would mean laying off at least two physicians, which would increase wait times for appointments, Bur said. Closing one clinic would increase drive times for residents who already travel as far as 45 miles for doctor's visits, she said. Reducing access to care would also frustrate the center's efforts to teach newly insured people how to stay healthy, Bur added.

"The people who don't have health insurance, they don't go to the doctor until something's wrong, and when something goes wrong they go straight to the emergency room," she said. "(We've) been trying to educate people to take care of themselves on the preventive side, rather than on the reactive side when something goes wrong.

Joe Ferguson, executive director of Advantage Health Centers, said his organization stands to lose $2.1 million of its $14 million budget if Congress doesn't renew funding. Through a partnership with the Detroit Medical Center, Advantage has a residency program for medical school graduates. Its first class of six resident physicians will graduate in 2016, returning six family practice doctors to the community.

If funding is cut, Ferguson said, Advantage will be forced to cut physicians and reduce health care access in Detroit.

"We would probably have to eliminate one of our delivery sites," he added. "There'd be more patients out on the street without access to primary care. And they'll end up back in the emergency rooms."

About centers

■The Affordable Care Act of 2010 encouraged the spread of "federally qualified" health centers to address the scarcity of prime care doctors in rural outposts and urban neighborhoods.

■ Michigan has 35 federally qualified health centers that give medical care at about 240 clinic sites across the state.

■ Metro Detroit has 13 centers, including eight in Detroit.

■ Up to 70 percent of federal funding for the centers is scheduled to run out in September.

Sources: Michigan Primary Care Association and Detroit News research