Affordable Care Act Expansion of Community Health Centers: Endeavoring to Ensure Insurance “Coverage” Equates to Health Care “Access”

cross-1-971655-m.jpgA premise of the Affordable Care Act (ACA) is to provide “affordable coverage” to more Americans with the idea being that newly insured individuals and families will have enhanced “access” to quality health care. Whitehouse Policy Snapshot. Particularly important is access to primary care, the means by which millions of Americans can obtain preventive care and better wellness as a way to avoid more expensive health care treatment in, for example, an emergency room. Following enactment of the ACA, there has been a strong push for previously uninsured Americans to obtain insurance via the new Health Insurance Market Place.

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That push appears to have succeeded to some extent. According to the White House, by virtue of the ACA, 8 million people have signed up for private insurance in the new Health Insurance Market Place, 3 million young adults have been able to stay on their parents’ health plan, and 3 million more people were enrolled in Medicaid and CHIP (as of February 2014) compared to before the Health Insurance Market Place opened. See FACT SHEET: Affordable Care Act by the Numbers. But being “covered” under insurance may not always equate to real access – or timely access — to health care. One reason for this reality is that as the numbers of enrolled insureds have increased under the ACA, the shortage of primary care physicians appears to have increased. According to Kaiser Health News (citing HRSA), about 20 percent of Americans now reside where there is an inadequate presence of primary care doctors to meet their health care needs. HRSA provides detailed demographic information demonstrating what areas/populations are medically underserved. Citing a report by the Association of American Medical Colleges, KHN reports that absent changes, there will be a shortage of 45,000 primary care doctors in this Country by 2020. And many doctors are leaving primary care practice due to the strains of diminishing reimbursement rates and an overbearing regulatory environment in which they ply their trade. So, with millions of new insureds needing the promised access to primary care, and an insufficient number of primary care doctors to deliver the care, how will the promised heath care “access” be obtained?

Federally Qualified Health Centers

For many new insureds under the ACA, the answer may be community health centers, such as Federally Qualified Health Centers (FQHC). An “FQHC” is a reimbursement designation. FQHCs are organizations that receive federal grants under Section 330 of the Public Health Service Act. With the FQHC designation, a health center qualifies for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs serve underserved populations with comprehensive medical services. Today, there are nearly 1,300 health centers that operate in over 9,200 delivery sites and provide care to approximately 22 million Americans. See The Affordable Care Act and Health Centers.

According to the US Department of Health and Human Services (HRSA) , “Health Centers are poised to play an essential role in the implementation of the Affordable Care Act. In particular, health centers emphasize coordinated primary and preventive services or a ‘medical home’ that promotes reductions in health disparities for low-income individuals, racial and ethnic minorities, rural communities and other underserved populations.” An FQHC is not just a medical clinic; rather, an FQHC is focused on the local community, neighborhood ties, and affiliations with local entities and connections.

The ACA authorizes a huge infusion of funding for FQHCs, establishing a five-year, $11 billion trust fund called the “Community Health Center Fund” for the operation, expansion, and construction of health centers. This money will allow FQHCS to hire approximately 3,000 insurance application counselors, “navigators,” who will help patients enroll in health plans under ACA, nationwide. The money will also be used to set up 300 new health center sites and support the construction and renovation of nearly 600 clinics. FQHCs, and the millions of Americans whose health care needs are met by them, stand to benefit by the ACA. Perhaps the expansion of FQHCs will meet the increased demands for health care that attend the coverage expansion.

With law offices in Atlanta and Augusta, Georgia, our business and health care law firm is focused on assisting FQHCs and other health care providers with regulatory compliance and audit issues. To schedule a consultation, call our Atlanta (404) 685-1662 or Augusta (706) 722-7886 offices, or email us at info@ksllawfirm.com.

*Disclaimer: Thoughts shared here do not constitute legal advice.

Sources: HRSA

Kaiser Health News

Association of American Medical Colleges

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