Federally Qualified Health Centers must grow to cover the uninsured and underinsured

Money should never be the reason people don’t get the health care they need, but it often is. That’s why in the 1960s, during the anti-poverty movement, the roots of Federally Qualified Health Centers (FQHCs) were created as a response to the struggles of poor communities to cover medical and mental health needs.

“They have quite literally become the backbone for health care for underinsured and low-income communities,” said Angela Quinn, CEO of FirstMed Health and Wellness Center.

In Nevada, six entities have the federal designation. While their 33 outlets for subsidized care crisscross the state, Quinn says needs still aren’t met.

“In Nevada, we should have about 100 FQHCs,” she said. “You look at our demographics: For every 7,000 people who are at or below median income, there is one doctor to provide primary care. It should be 2,000 to 1.”

Operational since 2009, FirstMed joined Nevada Health Centers in 2013 as one of the state’s FQHCs, which receive funding from the U.S. Department of Health and Human Services’ Health Resources and Services Administration. The money allocated is based on how many clients an organization is expected to serve, and it offsets what can’t be billed to Medicaid.

The clinics are based in low-income areas and target patients who lack insurance coverage either entirely or in terms of benefits, ranging from undocumented immigrants and refugees to seniors and newly released inmates. And Quinn says demand is rising.

“Our patient volume has grown so much — I know I need to put a clinic in North Las Vegas,” she said of the first of several planned expansions to FirstMed’s presence in the valley. Three locations in Las Vegas serve more than 9,000 patients yearly, and Quinn hopes to open a center near Henderson’s Water Street District. “The North Las Vegas (clinic, opening in December) is being funded by the state because the numbers were appalling there.”

More people have gained insurance in recent years through the Affordable Care Act, but gaps in coverage remain. Quinn says about 90 percent of FirstMed clients have some sort of insurance (about 85 percent qualify for Medicaid), but those plans usually fall short in covering chronic issues. She thinks the number of underinsured might increase with President Donald Trump’s latest executive order bringing back catastrophic health plans, which were mostly abolished under the ACA. These plans kick in during emergencies such as a car accident, but the high premiums and out-of-pocket copays mean primary care isn’t an option.

FQHCs are designed to bridge the gap. Patients pay on a sliding scale depending on their income and household size. There is a zero-copay option, and the maximum a person will ever pay for a visit is $75. “The average copay is $15,” Quinn said.

Even if there is no cost for the initial visit, sometimes a patient needs bloodwork or other testing that comes with the assortment of chronic conditions low-income people disproportionately face. Quinn says FirstMed works with specialists and labs to reduce the cost to patients, and payment plans are offered for remaining balances. “Say we negotiated the cost of radiology and you owe us $100,” she said. “We will put you on a payment plan for $10 a month.”

Bringing care to the people

Before any medical nonprofit secured the FQHC designation in the state, Nevada Health Centers was operating in rural areas with the same mission. Spokeswoman Carrie Tallman said the 40-year-old organization began its work in smaller towns, gaining patients through word of mouth.

By the time it became a FQHC in 1994, it already had statewide momentum. The designation just meant it could secure more and better funding.

“In many areas where access to health care is limited, the FQHCs are a resource (providing) the only source of care for many miles,” said Amy Roukie with the Nevada Health and Human Services Department. “The dedicated teams of providers working in this setting are invaluable to the individuals and communities they serve.”

Through Nevada Health Centers, 50,000 Nevadans receive care each year at 15 primary care centers, two dental sites, seven WIC (women, infants and children) sites and two school-based programs. In Las Vegas alone, there are seven brick-and-mortar outlets. Beyond routine care such as physicals, wellness exams and immunizations, they offer medical testing and imaging, community education and a Healthcare for the Homeless initiative.

“(FQHCs) help to prevent costly and time-consuming ER care that is unnecessary,” Roukie said of the pressure put on ERs by some uninsured patients seeking primary care. “If nonemergent care could be diverted to the FQHCs, hospital overcrowding and wait times would be reduced.”

For those who can’t travel to any outlet for care or live in places without the patient volume to sustain certain services, Nevada Health Centers has clinics on wheels. Breast imaging is done on its Mammovan, and dental work on its Ronald McDonald Care Mobile. “This model allows us to bring the medicine to the people,” Tallman said.

About 44 percent of clients are on Medicaid, 11 percent are on Medicare and 15 percent are uninsured, Tallman said, adding that the last number has decreased since the ACA. “However, since we do see undocumented people, we will always likely have a (patient) population that (is) uninsured.”

Insurance reimbursements account for 51 percent of Nevada Health Centers’ $35 million annual operating budget, 27 percent coming from the federal Health Resources and Services Administration and the rest covered by grants and partnerships. And like FirstMed, it’s looking at launching new clinics. “Coming down the pike,” Tallman said, “we are talking about bringing more.”

Beyond treating an ailment

The notion of clinics serving low-income communities may conjure an image of subpar facilities and care. But walking into FirstMed’s Shadow Lane location, which opened in 2016, it looks like any doctor’s office.

“We want everyone who works here to be willing to take their families here,” Quinn said.

FirstMed acts as a primary care provider, offering obstetrics and gynecology referrals, electrocardiographs, nebulizer treatments, chronic disease management, treatment and diagnosis for minor illnesses, sexually transmitted infection screenings and physicals (it refers patients to other nonprofits for vision and dental care).

But because of the populations it serves, care can go beyond treating an ailment. FirstMed has worked to secure more stable housing for clients and even helped pay for car repairs. “If it’s a pregnant mother of three who doesn’t have a car, we can pay for her ride,” Quinn said. “If it’s 105 degrees outside, we will get everyone a ride home.”

Operating on about $6 million per year, FirstMed relies on federal and state funding and a variety of private grants. “We get a grant from the state for those nonmedical wraparound services. Then we get anomaly grants, like $200,000 to hire someone to distribute (treatment) for medically managed opioid addictions,” Quinn said.

A $3 million Victims of Crime Act grant from the state was redirected after the Oct. 1 mass shooting on the Strip to “help meet the medical, emotional and financial needs of victims now and for months to come as they continue to heal.” According to a news release, that includes medical care, counseling and financial assistance for short-term living needs like mortgage or rent payments, food and prescriptions.

But this was a response to immediate tragedy. The lack of mental health services is an ongoing issue in Nevada, prompting FirstMed and Nevada Health Centers to add behavioral health to their offerings.

It’s one illustration of how FQHCs reach past their core mission of primary and preventive care for at-risk communities. Nonprofit status gives them the flexibility to apply funding to more specific areas of need, whether it’s mental health or the opioid crisis.

“We are still filling in the gaps as we see them,” Tallman said.