Daily Breeze

Health clinics serving most needy laying off staff, slashing services amid coronavirus pandemic

Patient visits are down dramatically, depriving the clinics of Medi-Cal payments and federal funding; some have shut down.

Community health clinics serving low-income patients, including the uninsured and the homeless, are reeling under the effects of the coronavirus crisis as they slash staffing, eliminate vital services and face the risk of shutting down.

A majority of these health-care providers receive federal funding to provide primary and dental care as well as behavioral health and wellness programs to underserved communities that struggle with health-care access. But those who run these clinics — ranging from large networks that operate several centers around Southern California to smaller ones that serve specific areas — say they are in the red and will likely have to shut their doors to vulnerable people during the global pandemic.

Moreover, many clinics may not be around to serve a flood of new Medi-Cal patients who are already resorting to social services as a result of losing their jobs and health insurance.

Loss of revenue

California’s stay-at-home order and social distancing measures have dramatically cut patient visits to community clinics, which rely not only on federal funding but reimbursements through the state’s Medi-Cal program.

Even though many of these clinics have rapidly pivoted to telemedicine, they have struggled to make up for the crippling loss of revenue, said Dr. Jason Lohr, CEO of the SAC Health System, which was operating five clinics in San Bernardino and one in Indio.

After the pandemic began, however, SAC Health System was forced to shut down two of its clinics. One of those shuttered clinics served the San Bernardino Unified School District that caters to about 80,000 children, more than 10% of whom are homeless.

“Now, they don’t have a health center to go to,” Lohr said.

Its vibrant dental practice, which served about 2,000 patients pre-COVID-19, is now closed except for emergencies. Lohr said 90% of the clinics’ patients are on Medi-Cal and about 5% are uninsured.

Overnight, they’ve had to switch from seeing all patients in person to 90% virtual visits.

“We’re now dealing with patients who don’t know what to do or how to do it,” Lohr said. “It’s a huge learning curve for them. And we’re running at a loss every day.”

During the pandemic, community clinics have also been dealing with the shortage of personal protective equipment such as masks, gloves, face shields and gowns.

Alexander Rossel, CEO of Families Together of Orange County at the community clinic in Tustin on Tuesday, April 21, 2020. The clinic provides services to those with chronic illnesses but Families Together of Orange County may be in danger of losing that building without Federal funding. (Photo by Leonard Ortiz, Orange County Register/SCNG)

Shutting down vital services

Things are even more difficult for clinics that look, act and are subject to the same rules and regulations as federally funded clinics, but don’t actually get that money.

Clinics such as Families Together of Orange County — with clinics in Tustin and Garden Grove — count heavily on patient visits and Medi-Cal reimbursements. About 20% of the clinic’s patients have no health insurance at all, said CEO Alexander Rossel, who has had to lay off 23 of the center’s 73 employees.

“We’re considered a safety net, but we don’t get grant money,” he said. “We are getting overlooked during this difficult time and we are struggling because funding is extremely limited.”

Rossel said that in addition to dental services, what’s really suffered at the center are the wellness programs for patients with chronic health conditions such as diabetes and hypertension.

“Our wellness center offered cooking classes, yoga, karate classes for kids, acupuncture, personal training and health education to low-income people,” he said. “Now, all that has been shut down. It’s very discouraging.”

Rossel said the clinic is still paying rent for its 5,000-square-foot wellness center, holding out hope that it  can bring back those valuable programs. “But it’s getting harder every day to hold on,” he said.

Larger clinics hurting, too

Larger community clinics that serve hundreds of thousands in Southern California are not doing any better.

AltaMed Health Services, one of the nation’s largest federally qualified health clinics that serves about 300,000 patients in Los Angeles and Orange counties, could be $125 million in the hole by the end of the year if the current situation with COVID-19 continues, said Berenice Nunez Constant, vice president of government relations.

The company did get $4.6 million in federal relief money, but that covers less than a month of its operational costs, she said. Constant said this is particularly troubling at a time when millions are losing their jobs and health insurance. Soon, those millions will resort to Medicaid and need these safety net clinics to provide care.

“But if we are not sustained right now, we’re not going to be here later when people really need us,” Constant said.

In addition to clinics, AltaMed also operates eight COVID-19 drive-thru testing and evaluation sites — six in Los Angeles County and two in Orange County. It costs about $125,000 per week to run the centers, but AltaMed has yet to receive federal funding to support these services, Constant said.

Borrego Health, which serves the Inland Empire and San Diego County, has shuttered nine out of 27 clinics, CEO Mikia Wallis said. A third of its employees have been laid off, furloughed or are working reduced hours, she said.

“We are reviewing our staffing needs and capabilities on a daily basis, that’s where we are,” Wallis said. “While we’ve been able to dramatically increase seeing patients via telehealth, we can’t do that for all patients. And our inability to see patients in person has had a huge financial impact.”

Vulnerable communities affected

More than 85% of Borrego Health’s patients are on Medi-Cal and about 10% are uninsured. A large number of them are Spanish-speaking, Wallis said.

“Our ability to see patients particularly in rural communities has been affected,” she said. “Patients may have to travel hours to get care or go without care. We’ve seen so many people move to Medi-Cal because of job losses. But our capacity to meet that need has not grown.”

Borrego also had to shut down weekend operations in the Coachella Valley due to cutbacks, and that affects the migrant farm worker population that counts on clinics being open during the weekends, Wallis said.

“We’re looking at having to furlough front-line staff clinicians, people who are dealing with the pandemic, and that’s scary.”

Many community clinics in the Inland Empire have shut down mobile units, dental services and school-based health centers, said Deanna Stover, president and chief executive officer of the Community Health Association Inland Southern Region, which supports community clinics and health centers in Riverside and San Bernardino counties.

“By our estimation, 40% of the clinics’ staff have been laid off, furloughed or working reduced hours,” she said. “Smaller clinics have either closed sites or drastically reduced services, and this includes free clinics serving the most vulnerable populations. It’s devastating.”

As the coronavirus crisis continues, these front-line safety net community health centers “will be decimated” if they don’t get substantial funding now, Stover said.

“Where are people going to go for health, behavioral and dental care in a month, two months or three?”