LA Community Clinics Say Pandemic Funding Woes ‘At Breaking Point’

Some community health clinics in California say they haven't been paid for more than a million COVID vaccination doses they’ve given to vulnerable residents in the past year.

Community health clinics have been the backbone of coronavirus vaccination efforts in low-income neighborhoods throughout Los Angeles. But due to a federal funding glitch, the clinics are owed millions of dollars in reimbursement for administering vaccines to people who receive Medicaid.

Known in California as Medi-Cal, the program offers health insurance to low-income Californians. Medi-Cal covers nearly half of the state’s children, one in five adults, and 2 million seniors and people with disabilities.

“We are very concerned. We've done 425,000 vaccinations, and we haven't been paid for any of those who are on Medicaid,” said Jim Mangia, CEO of St. John’s Well Child and Family Center in Los Angeles.

Under federal law, the government pays health centers a set rate for patient visits. Many state Medicaid agencies have said that if a patient receives a COVID shot along with other care, the clinic’s cost to give the vaccine is covered as part of its normal payment rate. But if they receive the shot at a mass vaccination site offered by a community health clinic, there are no other services provided and no way to bill for the single shot.

California was asked by the Centers for Medicare & Medicaid Services to work with health centers to devise a payment formula estimating how much it costs a clinic to administer a shot.

“We worked closely with the state on that. And they submitted it to CMS, and it still has not been approved,” Mangia said. “We're kind of in limbo. We don't know if it's the federal government that's holding it up, if it's the state government that's holding it up … it hasn’t been implemented yet.”

CMS told Kaiser Health News in October that it is reviewing proposals from 13 states to pay clinics for the vaccinations. If they are approved, the clinics would be paid retroactively.

The months-long delay has led to financial struggles, even as the community clinics do the much-lauded work of vaccinating L.A.’s most vulnerable residents.

“It's been very difficult. We did get some grant funding from the Health Resources and Services Administration … and from the state, a lot of private foundation dollars came in to support our vaccination efforts,” Mangia said. “It was a little bit of this and that and stealing from Peter to pay Paul, in order to mount this effort.”

Carlos Vaquerano, CEO of Clinica Romero, said his facility “is going through the same problem. We have vaccinated people, and we haven’t received any money.” Clinica Romero is based in the Pico Union-Westlake area of L.A.

The funding delay affects cash flow, and in turn the clinics’ ability to attract and retain health workers who can make more money elsewhere.

“It’s been more than two years, and St. John’s is still holding the front line," said Gary Po, outreach coordinator at St. John’s. "But we are getting to our breaking point and the community needs us more than ever now.”

A bill introduced in the state senate aims to shore up funding. SB 1014 would overhaul the state portion of community clinic funding and calls for $400 million in state funds annually, which would be used to unlock millions more in matching federal Medicaid dollars.

“We are putting forward a solution to address the persistent problem of underfunding our community clinics, the high turnover and shortage of health care workers that serve our state's most vulnerable and the financial strain of the pandemic,” said bill co-author, assembly member Wendy Carrillo (D-Los Angeles), whose district includes Clinica Romero and St. John’s.

Co-author Sen. Bob Hertzberg (D-Van Nuys) said more than 70% of community health center patients are people of color, while half are Latino and more than half fall 100% under the federal poverty line.

“Without the necessary funding, these clinics are unable to provide and pay the benefits to compete with other health care settings,” Hertzberg said. “When we fail to adequately fund these facilities, we fail our own communities and we fail our most vulnerable.”