SACRAMENTO: Community Clinics Suffer Under Managed Care

      The introduction of Medicaid managed care with multiple commercial plans can "have significant negative effects on nonprofit community clinics," according to a study of the Sacramento area that appears in this month's American Journal of Public Health. Dr. Carol Korenbrot, Grant Miller and John Greene of the University of California-San Francisco School of Medicine found that as Sacramento-area community clinics lost large numbers of low-income clients to Medicaid managed care plans, they also lost an important revenue source. Without the Medicaid reimbursements, the community clinics are left without a means to offset the cost of providing care for the uninsured. In analyzing 16 clinics in Sacramento County, 14 clinics in comparison counties and 140 clinics in other counties, the authors found "significant declines in Medicaid clients," face-to-face encounters and "charges and collections in licensed community clinics" between 1993 and 1995 in Sacramento County, coinciding with the rise in Medicaid managed care in that area. The number of Medicaid clients per clinic dropped 40%, service encounters slid 44%, Medicaid charges dropped 45% and collections fell 44%. On average, the amount each clinic collected from Medicaid fell from $244,000 to $137,000. Calling for additional monitoring, the authors advocate an examination of whether the clinics "have been compromised in fulfilling their role as safety-net providers to the uninsured" (6/99 issue).