Casa de Salud, a nonprofit clinic in Albuquerque, New Mexico, gives major medical care, opioid habit companies and non-Western therapies, together with acupuncture and reiki, to a largely low-income inhabitants.
And, like so many different well being care suppliers that function a security internet, its income — and its future — are threatened by the COVID-19 epidemic.
Casa de Salud clinicians, employees and well being apprentices stand outdoors their clinic, socially distanced.
“I’ve been working for the past six weeks to figure out how to keep the doors open,” mentioned the clinic’s govt director, Dr. Anjali Taneja. “We’ve seen probably an 80% drop in patient care, which has completely impacted our bottom line.”
In March, Congress authorized $100 billion for well being care suppliers, each to compensate them for the additional prices related to caring for sufferers with COVID-19 and for the income that’s not coming in from common care. They have been required to cease offering most nonemergency companies, and plenty of sufferers are afraid to go to well being care services.
But greater than half that cash has been allotted by the Department of Health and Human Services, and nearly all of it thus far has gone to hospitals, medical doctors and different services that serve Medicare sufferers. Officials mentioned on the time that was an environment friendly technique to get the cash starting to maneuver to many suppliers. That, nevertheless, leaves out a big swath of the well being system infrastructure that serves the low-income Medicaid inhabitants and youngsters. Casa de Salud, for instance, accepts Medicaid however not Medicare.
State Medicaid administrators say that with out quick funding, most of the well being services that serve Medicaid sufferers might shut completely. More than a month in the past, bipartisan Medicaid chiefs wrote the federal government asking for quick authority to make “retainer” funds — not associated to particular take care of sufferers — to maintain their well being suppliers in enterprise.
“If we wait, core components of the Medicaid delivery system could fail during, or soon after, this pandemic,” wrote the National Association of Medicaid Directors.
So far, the Trump administration has not responded, though in early April it mentioned it was “working rapidly on additional targeted distributions” for different suppliers, together with those that predominately serve Medicaid sufferers.
In an e mail, the Centers for Medicare & Medicaid Services mentioned officers there’ll “continue to work with states as they seek to ensure continued access to care for Medicaid beneficiaries through and beyond the public health emergency.”
CMS famous that states have a number of methods of boosting funds for Medicaid suppliers, however didn’t instantly reply the query concerning the retainer funds that states are searching for the authority to make. Nor did it say when the funds would begin to stream to Medicaid suppliers who don’t additionally get funding from Medicare.
The delay is irritating Medicaid advocates.
“This needs to be addressed urgently,” mentioned Joan Alker, govt director of Georgetown University’s Center for Children and Families in Washington, D.C. “We are concerned about the infrastructure and how quickly it could evaporate.”
In the administration’s explanation of how it’s distributing the aid funds, Medicaid suppliers are included in a catchall class on the very backside of the listing, below the heading “additional allocations.”
“To not see anything substantive coming from the federal level just adds insult to injury,” mentioned Todd Goodwin.
He runs the John F. Murphy Homes in Auburn, Maine, which gives residential and day companies to lots of of youngsters and adults with developmental and mental disabilities. He mentioned his group — which has already furloughed nearly 300 employees and spent greater than $200,000 on COVID-related bills together with purchases of important gear reminiscent of masks and protecting gear that won’t be reimbursable — has not been eligible for any of the varied assist applications handed by Congress. It will get most of its funding from Medicaid and public college techniques.
The group has tapped a line of credit score to remain afloat. “But if we’re not here providing these services, there’s no Plan B,” he mentioned.
Even suppliers who largely serve privately insured sufferers are dealing with monetary misery. Dr. Sandy Chung is CEO of Trusted Doctors, which has about 50 physicians in 13 workplaces within the Northern Virginia suburbs round Washington, D.C. She mentioned about 15% of its funding comes from Medicaid, however the drop off in non-public and Medicaid sufferers has left the group “really struggling.”
“We’ve had to furlough staff, had to curtail hours, and we may have to close some locations,” she mentioned.
Of particular concern are kids as a result of Medicaid covers nearly 40% of them throughout the county. Chung, who additionally heads the Virginia chapter of the American Academy of Pediatrics, mentioned that vaccination charges are off 30% for infants and 75% for adolescents, placing them and others in danger for preventable diseases.
The largest rub, she added, is that with the economic system in free fall, extra individuals will qualify for Medicaid protection within the coming weeks and months.
“But if you don’t have providers around anymore, then you will have a significant mismatch,” she mentioned.
Back in Albuquerque, Taneja is working to seek out no matter sources of funding she will be able to to maintain the clinic open. She secured a federal mortgage to assist cowl her payroll for a few months, however worries what’s going to occur after that. “It would kill me if we’ve survived 15 years in this health care system, just to not make it through COVID,” she mentioned.
KHN senior correspondent Phil Galewitz contributed to this story.