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Medicaid Gap Steers More Patients To Community Health Centers

Michael Tomsic

In Charlotte and across the country, there’s a growing need at community health centers. They treat patients regardless of their ability to pay. And the increased need is a surprising result to some clinic leaders, who thought the Affordable Care Act would mean fewer people needing charity care.

At the Charlotte Community Health Clinic, Nurse Practitioner Martha Brinsko treats a lot of uninsured patients for diabetes. Diana Coble is one of them.  

“Most mornings when you check your sugar, what would you say kind of the average is?” Brinsko asks Coble.

Coble hesitates before explaining she ran out of what she needs to check it, and she didn’t have the gas money to get back here sooner. Brinsko says Coble can get what she needs here.

“If you need to get more than one box, get more than one box,” Brinsko says. “But you need to check them every morning so that we can adjust things.”

Coble is unemployed, lives with her sister, and relies on the clinic for health care. 

“They do a great job with everything,” Coble says, “and I couldn't do without ‘em.”

The clinic’s executive director, Nancy Hudson, expected the Affordable Care Act exchange, or marketplace, to reduce the number of patients like Coble. But Hudson says the opposite happened.

“What we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people that didn't know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,” Hudson says.

The Medicaid gap is a big part of this. Obamacare was designed to cover the poorest people through Medicaid expansion, but the Supreme Court made that optional for states.

Ben Money is president of the association that represents North Carolina’s community health centers.

“Over half of the people that we see would've been eligible for Medicaid expansion had the state elected to exercise that option,” Money says.

North Carolina is among about twenty states that said no to Medicaid expansion. Many are in the South and under Republican leadership, like Louisiana.

Dr. Gary Wiltz is the CEO of 10 community health centers in southwestern Louisiana. 

“We've gone from 10,000 patients to 20,000 in the last six or seven years, so we've doubled,” he says.

Dr. Wiltz says there are other things at play. The slow economic recovery hasn’t reached many of the poorest people, and some who do qualify for Obamacare subsidies say their options are still too expensive. 

“The need keeps increasing, and I think that's reflected throughout all the states,” he says.

Dr. Wiltz also heads the board of directors for the National Association of Community Health Centers. He says clinics are packed even in states that expanded Medicaid. After all, the clinics treat Medicaid patients too.

Back at the clinic in Charlotte, executive director Nancy Hudson points out there’s another part of the Affordable Care Act helping with all this: additional funding for community health centers.

Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.  

“Many of their clients did not have any access to health care,” she says. “They can't train and sustain a job if they don't have the basic needs taken care of, and health care is one of ‘em.”

Nationwide, the federal government estimates its latest round of funding will lead to about 650,000 people getting better access to that basic need.