North country hospitals, clinics range from wary to worrying over series of federal funding cuts



Health care in the north country’s rural counties relies heavily on small, safety-net hospital and community clinics — institutions that may soon come to be hard hit by federal funding cuts.

As of Oct. 1, funding for several key health programs failed to be renewed by Congress, including the Disproportionate Share of Hospital payment program, the Health Centers Program and the Child Health Insurance Plan.

Disproportionate Share Hospital Payments:

According to the Centers for Medicare & Medicaid Services, federal law requires state Medicaid programs to make Disproportionate Share Hospital payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals.

The law also established an annual DSH allotment for each state, limiting the federal financial contribution to one total statewide payment. The payments, calculated by how much care hospitals provide uncompensated, are made to the state to be disbursed to qualifying hospitals.

The payment program’s expiration cuts $2.6 billion to public hospitals in New York State alone, which state Medicaid Director Jason Helgerson called, in a public statement, a blow to “(providing) critical care to millions of our most vulnerable citizens.”

“In 2017, the DSH payment we received was $474,000,” said River Hospital CEO Ben Moore III.

According to Mr. Moore, 56 percent of payments to River Hospital come from Medicaid and Medicare, an amount he described as “huge.” Without that payment, nearly all the hospital’s services are at risk.

“If we lose that ($474,000) it would have a significant impact. We’re breaking just over even right now, that would put us in the red,” he explained.

“(It would be) a significant challenge. There’s no real clean option ... We’d do our best to keep providing the best possible services for our community. We’re still searching for that best option.”

Mr. Moore said his isn’t the only hospital feeling the pressure. He said all public hospitals, especially small ones like those in the north country with no real money reserve, are facing significant difficulties.

“(This uncertainty) is not fair to our patients and it’s not fair to our staff. But we will deal with it the best we can.”

Mr. Moore said River Hospital is doing its best to avoid any losses to the community, patients and its employees.

Above all, he hopes that politicians can look clearly at the problems faced by hospitals and clinics like his and see the potential for compromise.

Krista A. Kittle, spokeswoman for Samaritan Medical Center, said DSH funding cuts could call the hospital’s current budget into question.

“As a not-for-profit hospital, any cuts that we face at (Samaritan) certainly cause us to look at our budget,” Ms. Kittle said in an email.

“If those cuts cannot be offset through revenue, then we have to turn to our expenses, such as supplies and equipment, programs, services, staffing and benefits, etc. in order to cover any gap as a result of these cuts.”

Mr. Moore had hoped for a quick legislative resolution, but said he hasn’t seen bills to restore funding or similarly tackle the issue go anywhere fast. The state is looking for ways to alleviate the burden on public hospitals, but details on how they intend to do this are yet unclear.

“What we’re trying to do is show impact. We’re not sure people understand the true loss this would be,” Mr. Moore said.

“The Healthcare Association of New York State ... is advocating on Capitol Hill for the swift redress of these cuts, as well as other cuts being proposed,” Ms. Kittle continued.

Carthage Area Hospital CEO Richard A. Duvall declined to comment at this time, calling it “too early.”

Of the remaining money held by the state for distribution, Mr. Helgerson said, “our priorities are fair allocations to all hospitals involved in the program, stability of the workforce and preservation of the highest levels of patient care.”

Health Centers Program:

“Congress’s failure to renew the Health Centers Program ... will cut $138 million in federal funding for New York’s 650 federally qualified health center sites,” Gov. Andrew M. Cuomo said in an Oct. 11 statement.

“Health centers provide high quality care to 2 million New Yorkers, including the vast majority of care for people under-insured in this state.”

North Country Family Health Center is a federally qualified health clinic in Watertown. In 2016 the clinic served 9,802 individuals who made 33,762 visits.

According to Executive Director Joey M. Horton, without a fix by Congress, community health centers like hers will feel the direct impact of going over the “fiscal cliff” at the start of their next budget period.

“There has been significant bipartisan support of legislation to renew the Health Center Program funding. Unfortunately, the legislation was not passed on time,” Ms. Horton said in an email.

“North Country Family Health Center’s current grant period ends on May 31, 2018 and therefore funding is secured until that time. For (us) that means that Congress must act by May of 2018 in order for the organization to continue to receive the full 100 percent of its anticipated grant funds.”

Gov. Cuomo further condemned the funding lapse in an open letter to Vice President Mike R. Pence, who visited Buffalo last week.

“We say no to devastating cuts to our health care clinics which serve those who need it most, providing the kind of care and access to our vulnerable populations that they can’t find in emergency rooms,” he wrote.

Child Health Insurance Plan:

The Child Health Plus Program, which began in New York in the 1990s and nationally became the Children’s Health Insurance Program, enrolled 346,067 children in New York alone last year.

U.S. Sen. Kirsten E. Gillibrand held a conference call last Tuesday afternoon, calling out Senate Republicans and urging New Yorkers to fight back against cuts to funding for children’s health insurance.

“Health care is one of the most contentious and partisan issues,” Sen. Gillibrand said in her opening remarks. “One program that is working well and has enjoyed broad bipartisan support is the Children’s Health Insurance Program.”

The program covers children in families that make too much to qualify for Medicaid, but not enough to afford other health coverage options. Nearly 9 million kids are covered by CHIP nationwide.

Almost 90 percent of children in CHIP come from families making less than the equivalent of $49,000 per year for a family of four.

North Country Family Health Center assists in the enrollment of on average 200 children in CHIP each year. The center provides care for approximately 165 CHIP- enrolled children annually as well.

“We know firsthand the important connection between health insurance coverage and access to care and are concerned for the children and families we serve who are covered by (CHIP) currently,” Executive Director Joey M. Horton said in an email. “No family should have to decide whether or not their child should receive needed health care because of their inability to pay for that care.”

Gov. Cuomo, in a public statement earlier this month, blasted the Congressional inaction.

“If we continue (the CHIP plan) after the feds pull out, that’s $1 billion directly to the State of New York without any sharing from any of the local governments because we pay for that directly.”

“Why a government would want to end health insurance for 333,000 children is beyond me and we use the word draconian and I think that’s a fitting word,” he continued. Sen. Gillibrand called New York one of the luckier states, as it would be able to fund the program into next March, while for many others the money will run out much sooner.

Still, Department of Health Commissioner Howard Zucker warned in a public statement last week that should Congress fail to renew federal funding for the program, Gov. Cuomo would be forced to call a special session of the Legislature in Albany to address the major budget shortfall.

When asked about the seeming lack of progress to reinstate funding for CHIP, Sen. Gillibrand cited a bipartisan bill to save the program.

The bill was passed by the Senate Finance Committee but has not been brought up for a vote by Senate Republican leadership.

Sen. Gillibrand blamed a single-minded focus by Republicans to repeal the Affordable Care Act.

More than 7,000 children in the north country rely on CHIP for health insurance.

“Health Center advocates including North Country Family Health Center are urging our elected officials to take action now to correct these issues,” Ms. Horton said.

“It remains a priority of the health center, along with other community health centers, to ensure our elected officials know how important it is to take action now to protect these vital services in our community.”

Jen JacksonComment