In the COVID-19 Pandemic, Community Health Centers Are the Front Line for High-Risk, Medically Underserved Communities

By Jessica Sharac, Peter Shin, Maria Velasquez, and Sara RosenbaumGeiger Gibson/RCHN Community Health Foundation Research Collaborative UpdateMarch 24, 2020Keeping community health care providers open and functioning during the COVID-19 pandemic is absolutely essential to controlling community spread and ensuring that patients have access to their regular source of health care. For urban and rural medically underserved populations, community health centers play this vital role; their mission is to reach the hardest to serve. In order to ensure that health centers remain open and strong, ongoing federal funding support is essential; 68 percent of patients served by health centers live in poverty, while 91 percent have incomes at or below twice the federal poverty level. In 2018, 1,362 federally-funded community health centers (CHCs) served nearly 28.4 million patients, including one in three individuals living in poverty. CHC patients are overwhelmingly low-income, and 63 percent are members of racial/ethnic minority groups. Health centers are a significant source of care for patients covered by Medicaid and CHIP – serving one in five enrollees across the U.S. – and serve 22 percent of all uninsured residents.Community health centers are especially important during the pandemic because they serve such high numbers of people at highrisk for severe illness from COVID-19. One in 11 health center patients is 65 years old, or older. More than 1 in 20 has asthma, about 1 in 7 adult patients has diabetes, and over 1 in 4 has hypertension. Compared to the general population, higher proportions of adult patients served by health centers have diabetes, asthma, hypertension, and report fair or poor health. Many patients have multiple chronic physical and mental health conditions. Table 1 shows the number of health center patients in 2018 who were elderly or who had a diagnosis of a chronic condition placing them at elevated risk for severe illness from COVID-19. More than 2.6 million health center patients were elderly, 1.3 million had asthma, 2.6 million had diabetes, and 4.8 million had hypertension.Table 1: Health center patients at high risk of severe illness from COVID-19COVID-19 high-risk factor or conditionCommunity health center patients in 2018 with selected conditionEstimated number of uninsured patients with high-risk factor or conditionsElderly patients age 65+2,601,57254,633HIV191,71713,420Hepatitis C195,94687,392Asthma1,309,728193,840Chronic lower respiratory diseases787,032176,295Diabetes2,566,358775,040Heart disease815,206125,542Hypertension4,778,1561,347,440Source: 2018 UDS national report and the 2014 Health Center Patient Survey [1]In addition to serving medically high-risk patients, community health centers serve hundreds of thousands of pregnant women. In 2018, health centers served 563,740 prenatal care patients and health center providers performed 172,106 deliveries – about five percent of the 3.8 million total births that year. The CDC recommends that pregnant women be monitored for COVID-19 due to their risk of severe viral illness.The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 included $100 million in funding for health centers “to prevent, prepare for, and respond to coronavirus” by providing and facilitating testing, screening, and triage for patients and community residents at large – both within the health center and in community settings. But today’s community health centers are a nearly $30 billion system – the largest primary care system in the U.S. for medically underserved communities. More support is needed. This necessary support must come in several forms:A multi-year extension of the Community Health Center Fund in order to enable health centers to maintain care for the uninsured. Currently, the Fund is set to expire by mid-May.An additional $1.32 billion in additional funding, as called for in the Senate’s pending legislation, to expand and strengthen health centers’ ability to respond for their communities during the pandemic. Inclusion of community health centers in states’ Medicaid 1135 public health emergency plans, which states are now submitting to HHS for approval, so that health center services can be fully covered and funded under Medicaid’s “Federally Qualified Health Centers” (FQHC) program, whether provided in clinical care or offsite settings. This includes telehealth communication. Especially urgent is lifting HHS restrictions on Medicare FQHC telehealth coverage during the emergency in order to ensure that community health centers are able to fully serve their more than 2.7 million Medicare patients. CMS has waived certain requirements specific to furnishing services via telehealth to Medicare beneficiaries for the duration of the COVID-19 crisis, but the prohibition on health centers acting as distant sites remains in effect. This restriction must be lifted to ensure the health centers can effectively care for at-risk patients during this national public health emergency.[1] The percentage of patients with each condition who were uninsured was calculated from the 2014 Health Center Patient Survey and these percentages were used to estimate the number of uninsured CHC patients with the diagnosis based on the 2018 UDS patient numbers for each diagnosis/condition.