States keep reducing health center funding

But more federal money is slated to bolster school-based facilities.

By Doug Trapp — Posted Dec. 26, 2011

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States reduced their funding for community health centers for the fourth consecutive year, but federal health officials in early December awarded another round of grants to help school-based health centers expand.

States are providing $335 million in local funding for fiscal year 2012, nearly $60 million less than for fiscal 2011, according to a study released Dec. 7 by the National Assn. of Community Health Centers. Thirty-five states provide such funding, which represents about 8% of total health center budgets, said NACHC spokeswoman Amy Simmons. Most other funding comes from Medicaid and federal grants. Some of the remaining support comes from private insurance, patient payments and community support.

The state cuts have led to service cutbacks, layoffs and even health center closures, the study found. Health centers use this funding in a variety of ways. Of the 15 states with specific budget line items for health centers, most require it to be used to care for the uninsured.

State spending on health centers peaked at $626 million for fiscal 2008, according to the report. The 2012 support is the lowest level since states provided $227 million for 2005.

Of the 35 states that fund health centers, 19 enacted cuts for fiscal 2012. Six cut their funding by more than 30%: Alaska, Hawaii, Iowa, Missouri, New Hampshire and Washington state.

New Hampshire reduced its health center support by $2 million -- a 47% decrease -- for fiscal 2012, according to the NACHC report. The cuts have forced some of the state's 18 health centers to lay off about 50 employees, including health professionals, and have increased patient waiting times for nonurgent care, said Tess Kuenning, MS, RN, director of the Bi-State Primary Care Assn., which also represents health centers in Vermont.

"We're still reeling from the effects," Kuenning said.

The cuts followed a Republican takeover of both chambers of the New Hampshire Legislature in November 2010, Kuenning noted. The state has no income or sales tax, and state lawmakers decided against finding new revenues to balance the state's budget, she said. New Hampshire Gov. John Lynch is a Democrat.

Six other states increased their health center funding at least slightly: Arkansas, Georgia, Massachusetts, New Jersey, Vermont and Wyoming.

Wyoming provided no health center funding for fiscal 2011 but allotted $1 million for fiscal 2012. The Wyoming Primary Care Assn. had asked lawmakers for $10 million to help start rural health centers and clinics, said Jan Drury, the association's director for state and federal advocacy. State physician and hospital associations supported the lobbying effort. Wyoming is in the process of setting standards to award the $1 million, she said.

Drury said the primary care association argued that local dollars were needed because Wyoming has not received additional federal health center funding. The national health system reform law is providing $11 billion to expand health centers, but federal grant applications are judged partly by the number of patients the health center will serve. Rural centers serve fewer people than urban centers, which leads to lower scores, she said. "It's really hard for our communities to meet the designations." Wyoming has two health centers and two satellite locations.

School health centers to expand

Meanwhile, the federal Dept. of Health and Human Services on Dec. 8 announced the latest round of health reform law grants to help school-based health centers expand.

HHS awarded $14.6 million in grants to 45 school-based community health centers. The funding is expected to allow the facilities to care for an additional 53,000 children in 29 states. The centers already provide care to about 112,000 children, according to HHS. The awards are part of the $200 million in support for school-based health centers that will be provided by the reform law by 2013.

The grants can't be used to pay staff, so these health centers mostly are expanding their locations and upgrading equipment. State funding for school-based centers often can't be used for capital purchases, said Linda Juszczak, MPH, president of the National Assembly on School-Based Health Care.

The size of school health centers and the services they offer vary greatly, Juszczak said. Some centers plan to use their grants for telemedicine equipment to expand access to specialists, while others are expanding their facilities or adding such services as dental care, she said.

These federal grants are a very significant investment for most of the centers, Juszczak said. "This money is very difficult to come by."

Although some school-based health centers have a physician on staff, many are primarily supervised by nurse practitioners, Juszczak said. Nearly every state has at least one school-based center.

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Shrinking state dollars for health centers

State funding for community health centers peaked in fiscal year 2008 and has declined steadily since then.

Fiscal year State health center funding
2004 $236 million
2005 $227 million
2006 $437 million
2007 $495 million
2008 $626 million
2009 $501 million
2010 $453 million
2011 $394 million
2012 $335 million

Source: "Calculating the Cost: , National Assn. of Community Health Centers, December (link)

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