Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — Last month, federal officials were supposed to announce $250 million in grants to help the nation’s safety-net clinics get ready for the thousands of now-uninsured adults who in 2014 are scheduled to be eligible for coverage through the Affordable Care Act.

But that didn't happen.

Instead, they gave out about $29 million to 67 clinics in 21 states and Puerto Rico. The $221 million reduction, officials said, stemmed from an earlier budget compromise built on an $80 billion cut in federal spending.

Nationally, 810 clinics, including seven in Kansas, applied for the grants; 743 came away empty-handed.

Extreme competition

“The competition was extreme,” said Cathy Harding, executive director at the Kansas Association for the Medically Underserved. “The lowest-funded application scored 102 on a 100-point scale. That means the grants only went to centers that were eligible for bonus points for things like targeting homeless or migrant populations or being in a frontier county.”

Two Kansas applicants were awarded grants: The Community Health Center of Southeast Kansas in Pittsburg received $275,000, and GraceMed Health Clinic in Wichita was awarded $525,000.

The five unsuccessful applicants were the Konza Prairie Community Health Center, Junction City; Heartland Medical Center, Lawrence; Health Partnership Clinic of Johnson County in Overland Park; Hunter Health Clinic in Wichita and the Health Ministries Clinic in Newton.

“Health Ministries Clinic scored 100 out of 100 points,” Harding said. “But they weren’t eligible for the bonus points.”

Jerree Forbes, who runs the Newton clinic, said he tried to document the clinic’s ties to the region’s migrant community but was unsuccessful.

“The criteria were very, very specific, and the evidence was very difficult to document,” Forbes said. “We tried, but we just couldn’t get it. I have to say we have enough trouble documenting what happens with the patients we see here at the clinic, but when you get into trying to document what’s going on in the community with people who are aren’t coming to the clinic, that’s pretty tough.”

Troubling conundrum

Forbes said the recent reduction in funding underscores a troubling conundrum in the national health reform debate.

“There is a significant disconnect between what has been passed in law and what is being funded,” he said. “There is a disconnect between what is needed in our communities and what has been funded, and there is a disconnect between what clinics are being asked to do each day and the funding that’s provided to them.

“But this is not surprising to me because, frankly, we (safety-net clinics) live in that disconnect. We live in that gap,” Forbes said. “It’s where we are; it's where our patients are.”

Krista Postai, executive director at the Community Health Center of Southeast Kansas, shares Forbes' concerns about the gap between expectations and funding.

“We got one of the grants, and I’ll be the first to say we’ve been incredibly blessed and we’re eternally grateful,” she said. “But at the same time, I’m concerned. Because if you stand back and listen to what’s being said it’s, ‘Hurry up and grow, but figure out how to do it on your own because we’re cutting your funding.’ That’s kind of crazy, don’t you think?”

Postai said the Pittsburg clinic will use its grant to open or expand satellite facilities in Montgomery County at Coffeyville Regional Medical Center and Coffeyville's lone elementary school.

“Actually, we won’t be starting a clinic at the elementary school,” Postai said. “We’ll be moving into the one that’s already there, and we’ll be making some modifications and expanding it.”

The elementary school, she said, has almost 1,100 students.

According to 2009 census data, one-fourth of the children in Montgomery County live in households at or below the federal poverty level.

New satellite clinics

GraceMed Executive Director Dave Sanford said the Wichita clinic will use its grant to open a satellite facility in the city’s low-income “Hilltop area” and start a program for the homeless.

“We’ll be partnering with programs like the Salvation Army, the Rescue Mission, St. Anthony’s Family Center and (Unified School District) 259’s outreach to homeless families,” Sanford said. “These are programs that are already feeding, counseling and providing shelter for the homeless. Our hope is to complement those efforts with health care services.”

The Hilltop neighborhood is near Via Christi Health System’s St. Joseph campus.

The plan is for the new clinic to become a medical home for nearby residents and for patients seen at Mother Mary Ann Clinic, which is next door to the St. Joseph hospital.

“The Mother Mary Ann Clinic is an urgent care, extended-hours clinic for people who don’t have medical homes,” Sanford said. “We’re going to offer those patients a medical home.”