Calif. Community Health Clinics Face New Challenges Under ACA

Community health clinics likely will treat more Medi-Cal beneficiaries under the Affordable Care Act, but the facilities also could lose patients who obtain private health insurance through the law, HealthyCal reports (Weintraub, HealthyCal, 10/7).

Medi-Cal is California's Medicaid program. Under the ACA, an expansion of Medi-Cal would affect individuals with incomes up to 138% of the federal poverty level, or $15,415 annually (California Healthline, 3/25).

ACA Implications for Clinics

Anthony Wright -- executive director of Health Access California -- said, "Many of the people [clinics] serve now are going to be paying customers, and those customers could potentially walk."

Wright added, "The question for the safety-net providers is whether they are going to try to actively chase those people who are newly insured or focus on the remaining uninsured."

In addition to losing patients, clinics also could experience lower payments because private insurers will not pay safety-net facilities the higher reimbursements that clinics typically receive from the federal government.

If such changes cause community clinics to close, their patients would have to find care at other facilities, causing a strain on the state's health care system, according to HealthyCal.

Jennifer Morton Kent -- executive director of a group representing county managed care plans -- said safety-net clinics likely will have to switch to a managed care model to survive.

"They're going to have to act more like other medical groups," Kent said, adding, "This is not a sustainable model."

Clinics Work To Retain Patients

Meanwhile, community clinics have been working for more than a year to upgrade their facilities to better serve patients.

For example, the Alta-Med clinic network in Orange County has:

• Partnered with Anthem Blue Cross to serve paying patients;
• Moved some clinics to larger facilities;
• Hired more internal medicine doctors;
• Hired patient guides and referral coordinators; and
• Opened pharmacies inside some of its facilities.

However, many clinics still are struggling to make changes amid uncertainty caused by:

• Medi-Cal reimbursement rates that are not yet finalized; and
• New provider networks for commercial health plans that were not finalized until Oct. 1, the first day of open enrollment for the state health insurance exchange.

Laura Mosqueda -- associate dean of primary care at UC-Irvine School of Medicine -- said, "Part of the challenge is preparing for the unknown" (HealthyCal, 10/7).