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Why California’s Community Health Clinics Are Vital, but Hurting

A mural painted by patients in the LifeLong medical clinic in East Oakland. Alexandra Hootnick for The New York Times

A look at the clinics that care for some of California’s most vulnerable patients.

Published April 13, 2020 Updated April 15, 2020

OAKLEY, Calif.— With chronic thyroid problems and stents in her heart, Caren Abell is one of millions of Californians with underlying health problems that make them especially vulnerable to the coronavirus.

Ms. Abell, 53 and unemployed, relies for primary care on La Clínica de la Raza, the only health clinic in this Bay Area suburb of 41,000. But now, it has been plunged into uncertainty.

La Clínica is part of a sprawling network of community health centers, mostly tucked in low-income neighborhoods, that have suffered huge losses of revenue in recent weeks as the pandemic prompted them to stop most patient visits to limit the disease’s spread.

Because the centers get most of their income from patient visits reimbursed by Medicaid, some clinic directors said they may have to close down in a matter of weeks or months.

“I’m not sleeping,” said Jane Garcia, chief executive of La Clínica, which has 35 sites in three Bay Area counties. The clinics, serving 90,000 people a year, have lost about $3 million in revenue over the past month, forcing La Clínica to raid its reserve funds. Nobody has any idea where its patients will go if it is forced to shut down.

“I really don’t even know what would be available out there,” Ms. Abell said.

La Clínica, and other community health centers like it, provides a range of services, including annual checkups, dental care and access to insulin for people who have nowhere else to turn. And many La Clínica patients have heart disease, hypertension or diabetes, the sort of pre-existing conditions that increase the lethality of Covid-19. “I don’t think anyone, really any part of the delivery system, is in a position to absorb what we’re doing,” Ms. Garcia said.

While there are nearly 13,000 community health center clinics in the United States, they play an especially important role in California, providing routine medical services for one in six Californians, including one third of the state’s Medicaid patients, nearly 500,000 migrant workers and 250,000 homeless residents.

“Their revenues are crashing at the worst possible moment,” Steve Glazer, a California state senator whose district includes La Clínica, said in an email.

Business plunged 80 percent overnight at Gardner Health Services, which runs seven health centers in Santa Clara and San Mateo Counties and serves about 50,000 patients.

In Los Angeles, South Central Family Health Center, which sees 25,000 patients a year, lost $90,000 in revenue during the last week of March. “That’s immediately unsustainable,” David Roman, a spokesman for the center, said.

Government authorities said they were aware of the problem and trying to help. Last month, the Trump administration awarded $100 million to health centers across the nation, of which nearly $14 million went to California. But out of this pool of assistance, only $145,000 found its way to La Clínica, barely enough to cover about a half-day of expenses for its clinics.

More help arrived via the recently approved $2 trillion federal package to address the pandemic. The relief bill included $1.32 billion for community health centers nationwide, a 25 percent increase to the $5.6 billion the federal government is already spending on the centers this year. California’s share was $192 million.

State officials have also acted. Dr. Bradley P. Gilbert, director of the California Department of Health Care Services, said in an email that his office was pushing for community health centers to get reimbursed through Medicaid for seeing patients remotely by telephone or over the internet.

Carmela Castellano-Garcia, chief executive of the California Primary Care Association, a lobbying group for community health centers, said the change, if adopted as expected, would give clinics a reprieve. But, she added, the struggle for survival is far from over.

Receiving health care over the phone is far from ideal for many of the people who rely on community health centers. They need their blood pressure monitored and someone to make sure they are taking their medicines, Dr. Paul Bayard, La Clínica’s chief medical officer, said. “Your vulnerable populations who haven’t been evaluated will be more at risk for things like heart attacks, strokes and falls,” he said.

The Oakley branch of La Clínica is quiet these days. Ms. Abell is struggling to adjust to the new reality of trying to get health care over the phone.

Her hands are so swollen by arthritis she can’t flip a light switch without pain. Her hands need to be X-rayed, a service La Clínica doesn’t provide, but her primary care doctor advised against going to the hospital because of the pandemic.

“I’m just kind of in limbo over here,” Ms. Abell said.

Katey Rusch contributed reporting.

Correction: April 15, 2020

An earlier version of this article described incorrectly the status of federal pandemic relief funds for community health centers. The money was released on April 8; it was not unclear when the funds would be distributed. The article also misstated the number of community health centers in the United States. There are nearly 13,000, not 11,000.


Production Staff & Crew

Miki Katoni ( 2020 )


Katey Rusch ( 2020 )

additional reporting