MNACHC LEGISLATIVE
AGENDA 2012
RURAL HEALTH ADVISORY
COMMITTEE
NOVEMBER 27, 2012
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COMMUNIT Y HEALTH CENTERS
THE BASICS
 Also known as Federally Qualified Health Centers
(FQHCs)
 51% of the Board of Directors are patients.
 Serve a Medically Underserved Area (MUA).
 Vital access points for all patients, regardless of income
or insurance status
 Comprehensive primary care including medical,
dental and behavioral health.
 Economic Engine in rural communities.
 2011 Direct=250 FTE, $24 million activity
 Sliding fee schedule to the uninsured and serve
everyone regardless of ability to pay.
 CHCs serve 1 out of every 6 uninsured Minnesotan.
 Roughly $39 million of care in 2011.
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CHCS IN GREATER MINNESOTA
SERVING 35,000 PATIENTS
 Scenic Rivers Health Center
(13,900 patients in 2011)
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Big Falls
Bigfork
Cook
Floodwood
Northome
Tower (2013)
 Open Door Health Center
(4,000 patients in 2011)
 Mankato
 Mobile Unit (Marshall, Gaylord,
Dodge Center)
 Lake Superior Community
Health Center (5,200 patients
in 2011)
 Duluth
 Migrant Health Services, Inc.
(6,800 patients in 2011)
 Crookston
 Glencoe (seasonal)
 Moorhead (including Battered
Women’s/Victim Advocacy
Program)
 N. Mobile Unit (75 mile radius of
Moorhead)
 Owatonna (seasonal)
 S. Mobile Unit (Blue Earth,
Brooten, Montgomery Sleepy Eye)
 Rochester
 Willmar
 Sawtooth Mountain Clinic
(4,800 patients in 2011)
 Grand Marais
 Tofte
 Grand Portage
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KEY DEMOGRAPHIC INDICATORS
Greater MN CHC Patient
Insurance Status 2011
Private
7,263
18%
Uninsured
15,233
38%
Greater MN CHCs Poverty vs.
State Averages, 2011
80%
70%
60%
75%
62%
50%
Medicare
4,791
12%
40%
30%
20%
10%
0%
MHCP
13,047
32%
32%
15%
10%
<100%
5%
101-200%
MN CHCs
>200%
MN State
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KEY TRENDS AT
GREATER MN CHCS
Growth in Very Poor
Patients
Growth in MHCP Patients
MHCP Patients
Patients <100% FPL
14,000
12,342
11,286
12,000
18,911 19,191
20,000
10,000
8,482 8,442
8,000
6,000
25,000
7,104
15,971
15,000
5,721
12,654 13,141
10,692
10,000
4,000
5,000
2,000
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2006 2007 2008 2009 2010 2011
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2006 2007 2008 2009 2010 52011
MNACHC 2013 LEGISLATIVE
PRIORITIES
Same Day
Mental Health
& Medical
Payment
Safety Net
Support
2013
MNACHC
Priorities
Measurement
of Quality
CHC
Appropriation
ACA
Implementation
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MEDICAID REIMBURSEMENT
CHANGE MA REIMBURSEMENT POLICY TO ALLOW CHCS PAYMENT
FOR A MENTAL HEALTH AND MEDICAL VISIT THAT OCCUR ON THE
SAME DAY
 CHCs strive to provide “one stop shopping” to many working
poor Minnesotans
 During the course of a medical visit, provider senses a
behavioral health need and provides a “warm hand-of f” to the
behavioral health staf f located at the CHC.
 Provide behavioral health visit as UNCOMPENSATED
 Ask patient to come back a subsequent day – INSENSITIVE TO OUR
PATIENTS.
 Integration of Mental Health & Medical care key strategy in
reducing medical costs (literature suggests 17% reduction).
 Health Care Home & Care Coordination
 Rural Health Clinics benefit from policy change?
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CHC APPROPRIATION
FUND THE CHC APPROPRIATION AT $5 MILLION PER YEAR – A
$2.7 MILLION INCREASE PER YEAR
 Under Minn.Stat. 145.9269, CHCs receive general funds
through MDH/ORHPC “to continue, expand, and improve
federally qualified health center services to low -income
populations.”
 CHCs use these funds for a wide range of purposes: e.g.,
practice transformation to achieve state Health Care Home
certification, maintaining CHC HIT system, staf f (medical,
dental and mental health) recruitment/retention.
 CHCs also use funds to PARTIALLY OFFSET the costs of serving
the uninsured.
 Uninsured patients increased 78% since appropriation established in
2007
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ACA IMPLEMENTATION
PROTECT PATIENT ACCESS TO CHCS UNDER MINNESOTA’S
IMPLEMENTATION OF THE AFFORDABLE CARE ACT
 CHCs will not experience same reduction in uninsured compared
to general state experience (Mass. CHCs experienced a 20%
reduction vs. 50% reduction in uninsured overall in Mass.).
 Expand MEDICAID to all below 138% of poverty
 Currently, 15,000 uninsured CHC patients in greater MN that would
benefit – coverage AND access to specialty care
 Establish a BASIC HEALTH PLAN for those with incomes between
138%-205% of poverty.
 Avoiding the “bronze trap” – low premium/high cost-sharing
 Mental health and adult oral health benefits
 Ensure CHC staff can continue to serve a “navigators/assisters”
for uninsured moving into the Health Insurance Exchange (HIX).
 Similar to existing HMO law, ensure that Qualified Health Plans
(QHPs) in the HIX contract with STATE DEFINED Essential
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Community Providers (ECP, MN STATE 62Q.19)
QUALIT Y MEASUREMENT
ESTABLISH A ROBUST RISK ADJUSTMENT METHODOLGY UNDER
STATE MEASUREMENT EFFORTS THAT RECOGNIZE THE SOCIAL
DETERMINANTS OF HEALTH
 As MHCP reimbursement evolves from
fee-for-ser vice to quality, measurement
of outcomes is vital.
 Current efforts (e.g., SQRMS, MNCM) only
“risk adjusts” on insurance status.
 In rural areas, key determinants include
(but not limited to): poverty, geography,
language and age.
 Without it
Data
Measure
Payment
 CHC patients may suffer access issues under
health care reform.
 “Cherry picking” continues.
 Recognize it is a “resource” issue, yet
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MNACHC actively leading a Task Force
SUPPORT OF THE SAFET Y NET
RESTORE/MAINTAIN/EXPAND FINANCIAL SUPPORT TO SAFET Y
NET PROVIDERS
 Safety net providers will not experience the same reduction in
uninsured patients that the overall state will experience
 Massachusetts – CHCs uninsured decreased by 20%, total patient
increased 31% between 2005-09.
 The “threat/reality” of the “underinsured” in ACA/HIX?
 Strategic investments into Minnesota’s health care safety net
(CHC partners!)
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RURAL WORKFORCE – ORHPC Loan Forgiveness & Grants/Loans
Critical Access Dental Provider payments
Restore MERC/DSH funding to targeted safety net hospitals
Alternative coverage programs such as Portico
HIT investments to enable participation in “reform” in rural areas
(e.g., Accountable Care Organizations)
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CONTACT US
mnachc.org
Jonathan Watson
Associate Director/
Director of Public Policy
[email protected]
twitter.com/mnachc
612.253.4715, ext. 11
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