Health Center News

This document is the official NACHC summary of the 340B Affording Care for Communities and Ensuring a Strong Safety-net Act, known as the 340B ACCESS Act. We focus on the sections relevant to health centers in our summary. This legislation is based on Alliance to Save America’s 340B Program and ASAP 340B’s policy principles. If you have any questions, please email regulatoryaffairs@nachc.org.

View NACHC Summary of 340B Access Act

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Federal funding for Community Health Centers expires September 30, 2023. NACHC is mobilizing thousands of health center supporters to reach out to Members of Congress – sending emails, making calls, and tagging them on social media – asking for a bipartisan funding solution.

Visit NACHC’s Grassroots Advocacy website to take action today.

Take Action

Message from Paloma Izquierdo-Hernandez, Chair of the NACHC Board of Directors

Learn more about federal funding for health centers in our new infographic:

This image has an empty alt attribute; its file name is Federal-Health-Center-Funding-101.png

Photo by: Noah Smith/Direct Relief
This article was reprinted with permission from Direct Relief.

Hollywood, California, and rural North Carolina have more than just distance separating them. But despite the cultural, economic, and weather differences, safety net health centers in each location report a shared challenge, one which is being exacerbated by Congress and political wrangling.

“It’s already hard to recruit people to work in rural areas, and it doesn’t instill confidence to have to ask Congress to remember us every few years,” said Leslie Wolcott, director of communications at Roanoke Chowan Community Health Center in North Carolina.

“Big picture, between cost-of-living increases, inflation, and the cost of doing business, retention is a huge issue, just being able to pay competitive wages. How do you sustain that?” said Adam Friedman, chief marketing officer at the Saban Clinic.

Federally Qualified Health Centers, which care for tens of millions of people in the U.S. annually at a fraction of the cost of hospitals, are set to lose their main source of federal grant funding after September 30 unless Congress manages to break its deadlock on the issue. This healthcare network, started during the Lyndon B. Johnson administration, has enjoyed bi-partisan support through the years, including a notable expansion during George W. Bush’s time in office, when funding for FQHCs doubled, leading to patient number increases of 60%. Currently, there are more than 14,000 FQHC sites, also called community health centers, across the U.S.

While health center leaders do not expect the funding to be withheld, ambiguity regarding the final amount of funding is already leading to negative impacts in terms of recruiting and weakening trust among community members, according to Wolcott and Friedman.

“The uncertainty about funding just adds another layer of challenge, an additional headwind”
Joe Dunn, vice president of the public policy and research division at NACHC.

Data from NACHC showed that in 2022, Medicaid provided 43% of revenue to FQHCs, Section 330 Federal Grants provided 12%, private third-party payers provided 12%, Medicare provided 9%, and the rest was paid by a combination of other grants, federal and not, as well as directly from patients and other sources. NACHC states the average cost of an FQHC visit is $322 compared to an average emergency room visit, which is $2,600 according to data from health insurance company UnitedHealthcare.

So far this year, more than 5.5 million Americans have been disenrolled from Medicaid. This could also impact health centers, as some people might not know they can still seek care at community health centers. However, these centers will likely face challenges with reimbursements for such uninsured visits, particularly if federal grants are not expanded and approved. Medicaid is the largest revenue source for FQHCs nationally, according to the National Association of Community Health Centers, an advocacy organization for community health centers.

“The role that health centers play in the health of the whole country is critical, so when you hear these kinds of things happening [funding cliffs], it’s concerning,” Friedman said. “It’s certainly concerning when you’re in the trenches of the health care system that we have and when you’ve been providing equal access to care for over 55 years, and you know the need is strong,” he said.

Friedman noted that the federal grant uncertainty comes at a particularly inopportune time, as behavioral health visitors increased by 50% in 2022, which will rise this year, and some of the local safety net programs, including at the county-level, do not cover behavioral health, forcing Saban to seek private donors to fill in the funding gaps.

Lenna Poulatian, Saban’s director of development, said that while past funding helped pay for a pediatric behavioral health specialist – pediatric visits have tripled since 2020 – future donations are at-risk due to the ongoing Hollywood strikes and broader economic uncertainty. Saban’s supporters include major Hollywood studios and networks as well as non-entertainment foundations and private donors.

In North Carolina, Wolcott said the timing comes RCCHC just broke ground on a new dental clinic. A hospital in their area, Martin General Hospital, recently closed, which will have ripple effects when it comes to primary health care access in the area, Wolcott said.

“Rural healthcare is really precarious,” she said. “When hospitals close, it messes up the primary healthcare system, and then it falls on FQHCs,” Wolcott said.

Further adding to the strain, many critical programs offered by RCCHC are not fully reimbursed, forcing the clinic to shore them up with additional funding from additional grants. These programs include mobile clinics for farmworkers, eye exams for diabetics, and colorectal screenings.

“We are providing care with not enough resources. And with every potential finding cliff, we have to lay out our core services to see what we would have to cut. Staffers hear this, and word gets around town,” Wolcott said, adding that, although no services have been curtailed, it reduces trust among the community.

“News spreads fast in a small town,” she said.

In LA, Friedman said Saban Clinic remains resilient and plans to continue to provide all services they currently offer, even with the uncertainty.

“We want to keep doing the work that we do, and we hope they (Congress) would see the value we provide,” he said.

Elizabeth Linderbaum, MPP, NACHC Deputy Director of Regulatory Affairs, contributed to this post.

Forty-five percent (45%) of health center patients suffer from hypertension, compared to 32% of the general population.¹ The good news is that high blood pressure (BP) is the leading modifiable risk factor for coronary heart disease, stroke, and congestive heart failure, and contributing factor for chronic kidney disease and dementia.

For health centers, Self-Measured Blood Pressure (SMBP) devices are an important tool in preventing and managing hypertension. Yet, recent moves by the Centers for Medicare and Medicaid (CMS) will make it difficult for health centers to use them for patients. CMS issued a preliminary recommendation to reject SMBP devices as DME, a key step in getting them covered for reimbursement. This decision would dramatically hamper the ability of health center care teams to empower more people to self-manage their blood pressure. NACHC is urging health centers to weigh in.

SMBP devices allow health center care teams to reach more people, more equitably, more quickly, and more cost effectively – in the comfort of a patient’s home. The American Medical Association and America Heart Association agree that the SMBP device meets all five categories required to qualify for durable medical equipment (DME) benefits.

1. SMBP Devices Satisfy All Durable Medical Equipment (DME) Designation Criteria

Criteria #1: Can withstand repeated use	SMBP devices are made to withstand repeated use.
Criteria #2: Effective with respect to items classified as DME after January 1, 2012, has an expected life of at least 3 years.	The recommended replacement time is every 5 years, exceeding the minimum 3-year lifespan threshold.
Criteria #3: Is primarily and customarily used to serve a medical purpose	CMS asserts that because “SMBP devices are generally not used by the patient to self-manage hypertension, but rather require clinical intervention to manage their medical condition…” they do not meet this standard. Yet, according to clinical guidelines, hypertension is treated with lifestyle modifications as well as medication. SMBP devices provide patients with real-time blood pressure (BP) measurement information that patients may respond to immediately, like remembering to take their medication, making dietary changes, adding exercise, and adjusting other health habits that impact BP levels. A common, true story: An uninsured Somali patient at a Washington state health center had high blood pressure (BP), diabetes, lipidemia, and transportation issues. By tracking her BP and other vitals at home with her own SMBP device, she took steps to drop 10 pounds and decreased her blood pressure within five months.
Criterion #4: Generally, is not useful to an individual in the absence of an illness or injury.	SMBP devices are indicated for individuals with suspected or diagnosed hypertension for diagnosis or blood pressure management purposes.
Criterion #5: Is appropriate for use in the home.	The SMBP device is appropriate for use at home. Another name for an SMBP device is “home blood pressure monitor.”

2. SMBP Devices Help Patients Self-Manage Their Health

A person with the #1 killer in the U.S., hypertension – also known as the “silent killer” – can respond to elevated BP levels immediately with lifestyle changes. The SMBP device offers immediate feedback, so people can take immediate action (see our response to Criteria #3) rather than having to wait for an appointment with a provider between BP readings.

SMBP is considered the gold standard for BP management. The pattern of readings—7 days of monitoring over 3 days, for a total of 12 readings—provides a more accurate picture of a patient’s true blood pressure. This allows patients to react and understand the impact of medication and lifestyle on their blood pressure. SMBP data shared with the care team enables accurate diagnosis and clinical assessment of a patient’s blood pressure over time as well as better medication titration.

3. SMBP Devices Works Similarly to Blood-Glucose Monitors, a DME

An SMBP device is a useful chronic disease management tool⁴ like a blood glucose monitor (which already qualifies for DME). Both devices reduce overtreatment, risk of emergency room visits, death, and severe illness – all while empowering patients to self-care with appropriate action.

Patients with diabetes rely on physician-created treatment plans similar to patients with hypertension. In both cases, patients use the data from their devices and their treatment plan to quickly respond to their readings.

4. SMBP Coverage Aligns with CMS’ Health Equity Goal

Despite its effectiveness, lack of reimbursement for SMBP devices has stymied widespread adoption and use of the SMBP device. Classifying SMBP devices as a DME can break down SDOH barriers especially for more vulnerable patients. This step furthers CME’s goals to achieve better health equity nationwide.

Coverage of SMBP devices as a DME would enable essential workers, people in rural areas, and people with transportation or childcare challenges, and low-income health center patients to self-manage their blood pressure information in partnership with their care team via telehealth. No matter a health center patients’ location, SMBP devices can help ensure they have equitable access to better manage their health.

Health centers have until May 31^st to provide comments to CMS about SMBP designation. Letters can be sent to HCPCS@cms.hhs.gov by 5PM ET on May 31.

To learn more please contact Meg Meador, Director of Clinical Integration and Education (mmeador@nachc.com) or Elizabeth Linderbaum, Deputy Director, Regulatory Affairs (elinderbaum@nachc.com)

NACHC’s Marilynne Mikulich contributed significantly to this article.

One of the highlights of the Conference for Agricultural Worker Health is the Migrant Health Awards ceremony. As Paloma Hernandez, NACHC Chair Elect of the Board and CEO of Urban Health Plan in New York, said about this year’s awardees:

“In a world that is increasingly beset with problems and tragedy, they inspire us by the example they set, their belief that we can become a more compassionate and just society – if we all do our part.”

Outstanding Migrant Health Center: Blue Ridge Community Health Services

The award is presented to a migrant health center that has demonstrated excellence and innovation in service delivery to Migrant and Seasonal Farmworkers. Incidentally, this year Blue Ridge Health is celebrating its 60^th anniversary. It was one of the first Migrant Health Centers established, following the signing of the Migrant Health Act in 1962 by U.S. President John F. Kennedy. Dr. MaryShell Zaffino, Chief Medical Officer and Kenett Melgar, Vulnerable Populations Manager, accepted the award.

The history of Blue Ridge Health mirrors the history of the Migrant Health Program. Its beginnings in Hendersonville, North Carolina were humble. Yet, it took root, thanks to nurturing by the founders, the doctors and nurses who volunteered, and people from the community who saw the great need for health care among hardworking Migrant and Seasonal Farmworkers. Learning to serve a population afflicted by hardship, the health center developed, like all Migrant Health Centers, the models of practice and core components that have defined the primary care home: patient-focused, culturally-sensitive care, patient education, bilingual services, outreach and enabling services.

Today, Blue Ridge Health is a vital and thriving community health system that serves a diverse population of some 45,000 patients in a 10 county-wide area. It has grown to include 22 primary care and behavioral sites and 34 school-based health centers. It is also a Teaching Health Center.

Thanks to the dedicated work of board members, administrators, clinical team and staff, it is leading the way and proving the value of a community-based health system for all people.

Outstanding Migrant Health Center Board Members

The Outstanding Migrant Health Center Board Member Award recognizes service and commitment on the Board of a Migrant Health Center. This year we honored two individuals.

Victoria has served for 18 years on the Board of Directors of San Benito Health Foundation in California.

Victoria Montoya, Board Member, San Benito Health Foundation

Born in Mexico and the daughter of migrant farmworkers, her roots run deep in the Migrant Health Movement. Back in the 1970’s, as a community activist, she gathered signatures from farmworkers — an effort that ultimately led to the creation a health center for agriculture workers in San Benito County.

Over the many years, Victoria has remained close to the farmworker community. She is alert to the hardships and health risks facing migrant workers and she has been an indispensable voice on the board, helping the center respond to the evolving needs of farmworker families.

Victoria has given service on the National Advisory Council for Migrant Health and, as a former teacher, has demonstrated a strong focus for strengthening programs and services for farmworker children, especially in oral health.

William Morgan, Board Member, Keystone Rural Health Center in Pennsylvania

For 22 years, Bill has served on the Keystone Rural Health Center board. Bill volunteers his time and energies for the purpose of improving the health and well-being of farmworkers. At Keystone Rural Health, Bill chairs the Agricultural Committee. He has also served on the National Advisory Council on Migrant Health. As a board member, he plays a strong role in the community—speaking out and building support for health center programs.

A retired college professor of languages, Bill is known to be ready at all times to offer help to those at the center in need of an interpreter or translator. In his spare time, he also serves as board member and secretary of the Fruitbelt Farmworkers Christian Ministry. As part of this ministry, he serves as an interpreter for groups visiting farmworker camps with food, clothing, and devotional support. Bill’s whole life exemplifies the spirit of volunteerism and community service. And for all the patients and staff at Keystone Rural Health – he is a trusted friend and supporter.

Outstanding Public Service Award: Edward Garza, CEO of the Mexican American Council in Florida

This award recognizes the leadership of individuals who have significantly shaped public policy and programs in Migrant Health.

A proud son of migrant farmworkers, Edward has devoted his life’s work to improve the status of farmworkers in the United States. Since taking the helm at the Council in 2017, Edward has carried forth its mission: To ensure that every farmworker child is provided access to a quality education, the arts and technology for a better future. He has successfully built growing partnerships with schools, businesses, and community organizations in Southern Florida.

His work has enabled the Council to leverage resources from the community and state and provide students with stepping stones and essential supports, such as job training, internships, mentoring/counseling, and scholarships.

Edward is also credited with the success of the Family Empowerment Program that engages farmworker parents and helps them contribute to the educational success of their children from kindergarten through high school.

Lifetime Achievement Award in Migrant Health: Karen Mountain

The 2023 Lifetime Achievement Award in Migrant Health honors the leadership and humanitarian work of our longtime partner and colleague Karen Mountain.

Last year Karen ended her tenure as Executive Director of the Migrant Clinicians Network—a position she held for 35 years.

The Migrant Clinicians Network (MCN), since its founding in 1984, has become a vital support system for health centers and clinicians on the frontlines who provide care and treatment to vulnerable populations. Among those populations are migrant agricultural workers – immigrants – and the multitude of refugees fleeing from war, disasters, and violence.

Under Karen’s guiding hand, MCN has broadened its global reach while expanding its array of informational resources, trainings and research to help clinicians respond to the health needs of mobile populations and meet emerging public health threats.

MCN has been invaluable connecting detained pregnant women and sick children to much needed healthcare. MCN is also at the forefront of environmental studies on climate change and its impact on farmworkers and marginalized communities.

Patients who used health centers as their usual source of care for three or more years had lower odds of high emergency department use, according to a new UCLA study funded by the Health Resources and Services Administration . The noteworthy findings were published last month in the Journal of Evaluation in Clinical Practice. Researchers looked at specific behaviors among patients, as well as indicators and patient care management approaches and how these factors tie into the frequency of emergency department visits.

Care-seeking behaviors were measured by whether the patient called the health center afterhours, for an urgent appointment, or talked to a provider about their concerns. Access to care indicators included health center continuity of care, transportation or translation services. Calling the health center after-hours, for urgent care, or being referred to specialists were linked to higher odds of frequent emergency department visits.

“Findings underscore opportunities to reduce higher frequency of ED visits in health [centers], which are primary care providers to many low-income populations,” concluded the report. “Our findings highlight the potential importance of improving patient retention, better access to providers afterhours or for urgent visits, and access to specialist as areas of care in need of improvement.”

This is not the first time that a study has linked lower rates of ER use among health center patients. A previous study published in the American Journal of Public Health (2016) also found lower hospital utilization and cost savings among Medicaid patients at health centers.

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