Medicaid eligibility redeterminations began in April, which means Florida health centers are helping patients retain health coverage or find other options if they are determined to be ineligible. Under the public health emergency’s (PHE) continuous coverage mandate, the state saw a significant increase in the number of individuals and families on Medicaid. In March 2020, it had 3.8 million enrollees. That number increased to 5.5 million enrollees in November 2022, according to the Florida Department of Children and Families.
The Florida Association of Community Health Centers (FACHC) supports the state’s community health centers, which provide affordable medical, behavioral health, and dental care to patients in underserved areas. FACHC Vice President and COO Ben Browning discussed the role of community health centers during the redetermination process, and other challenges they face, in this Q&A with State of Reform.
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State of Reform: What has FACHC determined to be some of the key challenges facing health centers?
Ben Browning: “The state is realigning Medicaid back to the pre-pandemic requirements (commonly known as Medicaid unwinding). This process will be a significant challenge for centers and their patients. It is the mission of FACHC to be there for everyone, providing access where individuals have no other options while remaining financially viable.
While about a third of center patients are currently uninsured, the anticipated influx of newly uninsured individuals will undoubtedly strain the resources now available at the 800-plus locations across Florida. Centers operate as not-for-profit entities, so whatever resources they bring in goes right back out to the communities they serve (which are mandated by federal law to be underserved communities).
Every center is preparing for the expanded base of patients from whom they may receive no payments. But without support from their communities, partners, and governments, they will have to begin scaling back their access to care to ensure that they remain viable over the long term. So if individuals or organizations are looking to make a positive impact as the PHE unwinds, we know some folks [they] can contact.
Health centers are also facing similar challenges as other providers, as well as some unique to the safety net. We all know of the provider shortage and the difficulty arising from inflation and competition for those providers. While health centers have a toolbox of resources they can employ to recruit and keep providers—National Health Service Corps, (and Federal Tort Claim Act) coverage, for example—the difficulty remains in staying competitive with the market.
FACHC works with each center to develop strategies that work best within their local environment (urban/rural, footprint/size, regional economics, etc.) to enhance their resources and approaches to ensure the primary care safety net remains intact and provides access to comprehensive primary and preventive care to all Floridians.
CHCs are still facing a constantly increasing attack from drug manufacturers and pharmacy benefit managers (PBMs), eroding the funding that is vital to sustaining and expanding access to necessary care for the uninsured, underinsured, and even those with insurance who all receive care at Florida’s CHCs.
The 340B Program was established in 1992 by Congress to enable safety net providers like health centers to purchase medications at a lower cost than the general market and be reimbursed at a fair rate. There is also a requirement for centers to reinvest those savings in patient care. This is key. CHCs are mandated to spend those savings generated through the program on building capacity and access to care for their patients: more providers, extended hours, reduced prices at the pharmacy counter, and more.
But the key is that every penny must go back into patient care. As these dollars get reduced by manufacturers and PBMs, that care gets reduced or eliminated, leaving many in Florida (rural communities, uninsured, etc.) with no access to care other than their local emergency room. While the PBM bill the legislature just passed was a huge step in the right direction, additional protections need to be put in place to protect the health and access to care for Florida’s residents.”
SOR: What are some ways in which FACHC can help health centers address these challenges?
BB: “FACHC works directly with centers to evaluate their current workforce environment and assess areas where they may seek additional resources or strategies to build their staff. While CHCs may have a different level of funding and staffing than others in their area—such as hospitals—their size, scope, and mission place them in a different position.
Enhancing plans for staff development, staff recruitment, and staff expansion are all core components to remaining a critical part of the primary care safety net. Being on the ground with each of the CHCs allows FACHC to get creative on finding solutions. While we bring new information to the table, it’s really a matter of the association learning from centers that enables the family of centers across the state to grow together.
The association has been working with centers, legislators, Congress, and regulatory entities for years in protecting the safety net in Florida. The legislature just passed a strong bill this session that enhances the oversight and authority of PBMs under the Florida Office of Insurance Regulation. And we would love to see this expanded to include protections for the uninsured as well.
For health centers, which provide the same access to care for everyone regardless of insurance status, protecting consumers through insurance contracts provides a cascading protection for the uninsured as 340B dollars would stay in communities as reinvestments in patient care, rather than with these third parties. By enabling centers to retain the margins between cost and reimbursement in contracts, it not only benefits the patients that are insured, but expanded access and reduced costs are also provided to the uninsured.”
SOR: Were there any bills that passed this session that might help address these issues? If so, how will they help?
BB: “Senate Bill 1550 was a huge win for patients and pharmacies across Florida. FACHC supported the language each step of the way—inspired by the governor, and spearheaded within legislative leadership—[to] cross the finish line, and get signed into law right away. While it doesn’t resolve the biggest pharmacy issue for CHCs (340B discrimination), it certainly addresses a number of other barriers to access for patients that independent pharmacists, hospitals, and CHCs have seen on a daily basis.
House Bill 635 is inspiring, and the centers are anxious to see how they can play a role in expanding access to dental care for indigent veterans. While we all await the specifics, centers are prime examples of potential partners for this program, already being a hub for indigent care and having a special place in their hearts for veterans, with many veterans [serving] as CHC CEOs, providers, and frontline employees.
SB 240 should be applauded for its creativity and ingenuity. While many such programs are already in place, this bill goes a few steps further to build the next generation’s workforce. Centers have been looking into, and engaging in, these types of strategies with their education partners (local school boards, technical colleges). The enhanced support and funding from the legislature to support these programs, loan forgiveness/repayment, and other workforce initiatives is a clear demonstration of the state’s commitment to Florida’s future (health, employment, education, and economics).”
This Q&A was edited for clarity and length.