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Health centers serving region’s poor brace for cuts as federal shutdown looms

January 17, 2018


Isa Gonzalez is seen with her daughter Ella Burnett, 4, at their home in Worcester. 

WORCESTER - Four-year-old Ella Burnett is a bundle of preschooler energy, proudly showing off her toys to a visitor at the apartment where she lives with her mother, Isa Gonzalez.

She takes her pink-flower-adorned doctor’s kit, pulls out a stethoscope and listens to her teddy bear’s heart.

Talking about her own medical encounters, Ella said, “The girl doctor gave me a shot. She said I was brave. I’m not sick anymore.”

Ella has had a lot of contact with the health care system. She has asthma, for which she takes albuterol sulfate as needed, and budesonide, a steroid, during the winter.

When she was 3, she developed a hip infection, which caused her to be hospitalized for a week with intravenous antibiotics.

The cost of hospitalization, MRI to diagnose her hip and medication alone would come to thousands of dollars. But Ella’s mom, Ms. Gonzalez, 24, hasn’t had to worry about crippling medical bills because Ella is covered under the Children’s Health Insurance Program, or CHIP.

CHIP is a government-funded comprehensive insurance program for low-income children who do not meet Medicaid eligibility requirements because their family income is above the Medicaid limit.

Ms. Gonzalez, who works full-time as a unit clerk at Family Health Center of Worcester, earns $13.90 an hour, which comes to a little more than $28,000 a year. Ms. Gonzalez is eligible for Medicaid for her own coverage, but she was told that Ella would have to apply for CHIP.

CHIP, which expands coverage under the state’s Medicaid program known as MassHealth, has been a godsend to families like Ella’s and some 186,000 other children in Massachusetts, according to a report by the Georgetown University Health Policy Institute and American Academy of Pediatrics.

The future of the program is in jeopardy now as a partial federal government shutdown looms Friday, while a long-term agreement to continue funding the decades-old bipartisan program still hasn’t been reached.

Connecticut recently closed CHIP enrollment and indicated coverage would extend for existing enrollees only through February unless additional funds became available.

Massachusetts officials say that if Congress does not reauthorize funding for CHIP, which reimburses the state for 88 percent of spending, federal money will end in April. The estimated loss of federal funds to the state is $50 million until June 30, and $295 million annually starting in the state’s fiscal year 2019.

The thought of having to come up with some other way to cover Ella’s health care expenses scares Ms. Gonzalez.

“I think it’s just tough because of her health conditions, because of the cost,” she said.


Cutbacks in coverage for low-income children aren’t the only threat to the health care safety net tied up in the government funding standoff.

Community health centers, which provide primary care, preventive services, dental and eye care, substance abuse and behavioral health services to nearly 900,000 state residents, including 55,000 in the Worcester area, are facing a 70 percent cut in federal subsidies.

If reauthorization doesn’t pass and funding is cut, 140,000 statewide would lose access to care and 800 jobs would be lost, according to James W. Hunt Jr., president and CEO of the Massachusetts League of Community Health Centers.

“It’s the indirect impacts we’re worried about,” Mr. Hunt said. The state’s 39 federally-funded community health centers would hit roadblocks trying to hire doctors and nurses, expand outreach sites or work with a bank on a line of credit. “All these things become questions.”

Whether in urban centers where diverse communities find a medical home, or in isolated rural areas where the community health center is the only local source of care, Mr. Hunt said, health centers have “saved thousands of lives.”

He and health center directors are working with the state delegation in Washington to reach across the aisle and make the argument that investment in the health safety net creates savings, too.

“As soon as you don’t have capacity, off you go to the ER,” Mr. Hunt said. “We think we’re a solution rather than part of the problem.”

“Obviously, it’s a very uncertain and challenging time,” said Toni McGuire, president and CEO of the Edward M. Kennedy Community Health Center. “It really does threaten the public health system in our country.”

The Edward M. Kennedy Community Health Center serves 28,000 patients a year at 12 sites, including school-based health centers, in Worcester, Milford and Framingham. It also has a dental clinic in Clinton.

About half of its patients are covered by MassHealth or CHIP.

If federal funding were sharply cut, both from direct grants and patient insurance, “We would have to eliminate some service lines potentially. We would have to close sites, potentially,” Ms. McGuire said. “We have frozen a great number of positions in our health center.”

The organization is even more conscious about planning, moving forward, she said. “For us, it’s about sustainability and keeping access to health care to people in poverty.”

Cutting by 70 percent the roughly $4.2 million federal grant that Family Health Center of Worcester receives each year “would cut services to patients,” said Frances M. Anthes, president and CEO. “A lot of work that we’ve evolved, whether it’s prevention, whether it’s opioid services, would be vulnerable.”

Family Health Center provides health care to 27,000 patients a year, not including its Women, Infants and Children nutrition program, at 16 sites in Worcester and Southbridge, including school-based health centers, and dental services in Webster public schools.

Two out of three Family Health Center patients are covered by MassHealth or CHIP.

Nearly all - 96 percent - of patients have income levels below 200 percent of the federal poverty level, and four out of five live below the poverty level.

In 2017, the federal poverty level for a family of four in Massachusetts was $24,600 a year.

Medical interpreter services are also paid for by a federal grant. Fifty-four languages are spoken at Family Health Center, and physicians and nurses rely on interpreters not just for translation but also cultural interpretation.

“Massachusetts has had a commitment since Gov. Romney that health care is a right, not a privilege. This would basically be reversing that commitment,” Ms. Anthes said.

Dr. Laura Sturgill, a family medicine physician at Family Health Center’s main location on Queen Street, said she worried about cutbacks in preventive care and screenings for children as well as care for children with chronic conditions such as asthma, obesity and attention-deficit disorders.

“The earlier we find (problems), the better the outcome,” Dr. Sturgill said. “I worry if we aren’t providing basic preventative services, things will be missed.”

“I worry about the dental, the oral health program,” Ms. Anthes added, pointing out that Worcester does not fluoridate its drinking water. “We know that bad oral health has implications in the long term.”

Family Health’s Queen Street center has a busy dental practice, with 12 operatory chairs, and on a recent visit, a full waiting room. The Southbridge center has four chairs.

Ms. Anthes said that because of funding cycles, the money won’t stop on Friday if resolution isn’t reached. But the board will have to make decisions within a month or two.

She said the board has already declined opportunities for expansion because of the money uncertainty.

“We’re really fighting with each other about basic values because we see the role of government differently. While we haven’t resolved that, the victims of that are going to be our children, which doesn’t make sense to me,” Ms. Anthes said.

She continued: “I think we’re better than that as a society. In some ways, we’ve lost sight of that. We’ve lost our way.”

Susan Spencer

Worcester Telegram & Gazette

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