An Early Assessment of the Potential Impact of Texas\u27 Affiliation Regulation on Access to Care for Low-income Women

This analysis provides an initial assessment of the implications for low-income women of Texas\u27 affiliation regulation, which would bar Planned Parenthood Federation of America (PPFA) clinics from participating in the Texas Women\u27s Health Program (WHP). In 2010, more than 183,000 women were enrolled in the WHP, which provides health screening, family planning and birth control to low-income women, and nearly 106,000 received care through the program. In our analysis of WHP provider data, we find: Planned Parenthood (PPFA) clinics are by far the dominant source of care under the WHP. In FY 2010, PPFA clinics accounted for approximately 49 percent of all WHP-financed care, furnishing services to 51,953 WHP clients out of 105,998 WHP clients served. Of the 1,469 providers that billed the WHP in FY 2010, 908 (62%) served 10 or fewer patients, while 368 (25%) served only one patient. By contrast, in the same year the state\u27s community health centers served 10,130 WHP clients. Although health centers are the major source of care for the state\u27s poorest residents and provide family planning services to thousands of traditional Medicaid beneficiaries, they attract fewer numbers of Medicaid expansion beneficiaries served through the WHP, who tend to be somewhat less poor. In order to offset the loss of PPFA clinics in WHP, health centers would have to expand their WHP capacity five-fold, from slightly more than 10,000 patients to over 62,000 patients. Such an expansion in a short time period is virtually impossible, particularly given the simultaneous and steep loss in family planning grant funding experienced by health centers along with other family planning programs throughout the state. The state\u27s estimates of the impact of the loss of PPFA capacity under its affiliation rule appear to contain numerous methodological flaws. The estimates may overstate remaining provider capacity in communities in which WHP clients reside, do not take into account the fact that unlike PPFA clinics, many WHP providers treat only a handful of patients, and may count reference laboratories as sources of direct patient care. As a result, we estimate that the affiliation rule may jeopardize family planning, cancer screening, and preventive health care for approximately 52,000 women currently served by PPFA clinics under the WHP

Assessing the Potential Impact of the Affordable Care Act on Uninsured Community Health Center Patients: A Nationwide and State-by-State Analysis

In this brief, we estimate the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. We find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients – or two-thirds of all uninsured patients served by CHCs nationally – would be eligible for coverage. However, over one million uninsured patients – 72% of whom live in southern states – who would have been eligible for coverage will remain uninsured because of states\u27 decisions to opt out of the expansion. The spillover effects of the decision to opt out of the Medicaid expansion are likely to be significant. Health centers in opt-out states can be expected to struggle, falling further behind their expansion state counterparts in terms of service capacity, number of patients served (both insured and uninsured), and in their ability to invest in initiatives that improve the quality and efficiency of health care

How Has the Affordable Care Act Benefitted Medically Underserved Communities? : National Findings from the 2014 Community Health Centers Uniform Data System

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured. The UDS data show the ACA’s major national impact on both medically underserved communities and community health centers. Between 2013 and 2014, the number of health center patients with health insurance rose by more than 2.3 million (a 17 percent increase), the number of uninsured patients declined by 1.2 million (a 16 percent decrease), and the total number of patients served rose by over 1.1 million (a 5 percent increase). Since 1996, the total number of patients served at federally funded health centers has nearly trebled, from slightly more than 8 million to almost 22.9 million patients served by 2014. Consistent with the fact that over 70 percent of health center patients have household incomes at or below 100 percent of the federal poverty level, of the 2.3 million increase in insured patients, approximately 79 percent is the result of an increase of 1.8 million in the number of patients covered by Medicaid. Between 2013 and 2014, the number of privately insured health center patients also rose, from 3.1 to 3.6 million, an increase of 16 percent and by far the greatest increase in private insurance coverage over the 1996-2014 time period. These findings point to the importance of the ACA in the nation’s poorest communities, while also emphasizing the vital role played by Medicaid. The UDS results also underscore the major expansion trajectory for community health centers as a result of insurance expansions and direct Congressional investment in continued health center growth. These findings also reveal that as patients gain coverage, they remain with their health centers, even as health centers continue to reach more community residents

Quality of Care in Community Health Centers and Factors Associated With Performance

Federally funded community health centers are a key source of comprehensive primary care for medically underserved communities, serving more than 20 million patients in 2011. The Affordable Care Act (ACA) expanded the health center program significantly to help meet the increased demand for health care that is expected as millions of the uninsured gain health coverage, beginning in 2014. Especially given health centers’ growing role, evidence of the quality of care they provide is of keen interest. Most research shows high performance by health centers relative to various standards, but some gaps have also been found, and suitable benchmarks for assessing the quality of care provided by health centers, which serve a uniquely disadvantaged population, have been lacking. Recently, the Kaiser Commission on Medicaid and the Uninsured (KCMU) partnered with the George Washington University to analyze health center performance relative to Medicaid managed care organizations (MCO), which also serve a low-income population, on important measures of quality of care – diabetes control, blood pressure control, and receipt of a Pap test in the past three years. The study also aimed to identify factors that differ significantly between high-performing and lower-performing health centers. Using data reported in the federal 2010 Uniform Data System (UDS) by health centers and the 2008 Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid MCOs, we defined health centers as “high-performing” if their rates exceeded the 75th percentile of Medicaid MCO HEDIS scores on all three of our quality measures. We defined health centers as “lower-performing” if their rates were below the mean Medicaid MCO HEDIS score on all three measures

Community Health Centers and Medicaid Payment Reform: Emerging Lessons from Medicaid Expansion States

Community health centers represent a major source of primary health care for the nation’s Medicaid beneficiaries. Because the Federally Qualified Health Center (FQHC) payment system is encounter-based, health centers and Medicaid agencies in ACA expansion states are actively pursuing payment reforms that will enable health centers to adopt strategies that can more effectively respond to the considerable and complex health and social needs of people served by health centers, and more efficiently address the surging volume of patient care. In five expansion states whose alternative payment experiments are underway, health centers and Medicaid agencies are testing payment alternatives, such as global payments, that link payment to performance while ensuring that the FQHC hold-harmless standard is met and that total revenues do not fall below the FQHC floor. These alternative payment approaches enable health centers to test new strategies to address the needs of their patients, while enabling state agencies to align these strategies more closely with broader payment reform efforts