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It's hard to miss the pop-up canopy outside the AltaMed clinic in East L.A. It's an outdoor waiting space where patients often line up. With a large banner reminding folks to get counted in the 2020 Census, it doubles as an active place for civic engagement.
Since March, AltaMed has been active in efforts to inform Angelenos about the census. In fact, responding to the census is even given as a "prescription" to patients before they leave.
AltaMed is also the only clinic organization to have its own census kiosks in L.A., with few other groups having the resources to fill that technology gap safely.
"One of the things that I've been telling our legislators is that, if we did have access to fund someone here for an entire day, for seven days a week -- because that's when we're open -- we'd be able to be really, really successful," said Jennie Carreón, the associate vice president of civic engagement for AltaMed.
But funding for their kiosks is set to expire again at the end of July, which is a concern for Carreón, considering the county self-response rates is still under 60% and that there's a lot at stake in the census for community clinics.
"We are in the middle of a pandemic and financial economic downturn, resources all around will be scarce, and that includes funding for [federally qualified health centers] and hospitals," Carreón said. "This is why it is so important that underserved communities fill out the census so that we don't have additional social structural barriers to add to an already challenging environment."
CENSUS IMPACTS ON COMMUNITY CLINICS
There are concerns that the combination of layoffs, low census turnout and increased Medicaid eligibility for people who've lost work could create a strain on resources for the clinics in years to come. Among other factors, census data helps determine how much federal funding these clinics get.
Federally qualified health centers, or FQHCs, such as AltaMed, are facilities that receive funds from the Health Resources and Services Administration to offer primary care in medically underserved areas. AltaMed is among the dozens of clinics operating in L.A with this designation.
The Community Clinic Association of Los Angeles County is a coalition of private nonprofit community clinics and health centers whose 65 members, including AltaMed, serve 1.7 million patients each year at more than 350 sites. Many of the association's member clinics are FQHCs.
As many Angelenos have lost work this year amid the pandemic, this opens the door for increased Medicaid enrollment. Louise McCarthy, president and CEO of the clinic association, said that while an anticipated increase in demand has yet to hit, analysts are watching the numbers.
"By standard California mass, Los Angeles [is] usually a third of the state. That means you'd be looking at potentially a million new Medicaid enrollees here," McCarthy said.
McCarthy said that currently 63% of their patients rely on Medicaid, and many clinics have already lost a lot of their funding because of the coronavirus, despite the CARES Act and state protections. Low census response could make things much worse.
"If we get under-counted, the funding that comes to the states to support our Medicaid program could potentially force the state to cut back," McCarthy said. "If any cuts come to programs for some health centers, it will be a more immediate impact than for others just based on how much cash they've got in the bank."
It could also hurt the recruiting of staff, McCarthy added. Community health centers are placed in identified areas that lack medical resources. But these communities compete for funding through a ranking system -- with L.A. County having an overall higher need than its neighbors. If you're higher up the list, you have more access to funds, including a program that community clinics use to attract new providers by paying down student loans.
WHAT'S NEXT FOR CLINICS
The financial stability of the federally qualified health centers is more precarious than ever, which is why Carreón and McCarthy see census work as necessary. And while the 2020 Census doesn't ask about income, it works to further inform data gathered by the U.S. Census Bureau in other surveys in combination with patient income data.
"One of the struggles of Los Angeles is we've got the Malibu skew," McCarthy explained. "Our data is skewed by incredibly wealthy folks living not too far away from folks who are in either extreme poverty, or are generally low income. We have to always make sure that the folks who are hardest to count get counted. Otherwise, our more affluent neighbors are going to make L.A. look a lot more resourced than we really are."
More affluent residents tend to complete the census in higher numbers. This frequently leaves undercounted folks -- many in non-white communities -- out of the equation because they're not represented in the data. To help alleviate this issue, community clinics are ramping up their outreach.
The Community Clinic Association of L.A. County hopes to boost responses to the census by working with the bureau and its members to host mobile kiosks at clinic sites in early August. These will be outdoors to reach patients getting COVID-19 tests or picking up donated food.
Some clinics are distributing flyers at food drives and adding information to text and phone call appointment reminders. AltaMed is working on extending its kiosk to October, but its sites will still do census engagement though its staff and materials.
"We've been here for 50 years," said Carreón, "and we're going to be here for another 50 years -- God willing."
