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LA Community Clinics Vaccinate The Most Vulnerable. A Year Later, They Still Haven’t Been Paid

A young man wearing a backwards baseball cap sits at the check-in desk at the St. John's Well Child and Family Center clinic in the South LA neighborhood of Avalon. A woman in a plaid red-and-black jacket stands off to the side. Two masked workers are behind the long desk, which is partitioned into several stations.
St. John's Well Child and Family Avalon Clinic in South L.A. administers about 100 COVID-19 vaccines daily.
(Jackie Fortiér
/
LAist)
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Some community health clinics in Southern California say they haven't been paid for millions of COVID-19 vaccination doses they’ve given to vulnerable residents over the past year.

Clinics have been the backbone of coronavirus vaccination efforts in low-income neighborhoods throughout Los Angeles, where residents are more likely to both contract COVID-19 and die from it. Due to a federal funding glitch, the clinics are owed millions of dollars in reimbursement for administering vaccines to people who receive Medicaid.

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Community Clinics Can't Wait Much Longer For Feds To Pay Up

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

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

To get as many people vaccinated as quickly as possible, Mangia and other health clinics set up vaccine-only sites across the county starting in Jan. 2021. The vaccine doses were provided by the L.A. County Department of Public Health, but community clinics covered all the other costs for more than a year.

“We opened 26 vaccine centers, and we deployed three mobiles and a van to do pop-up vaccinations across the county,” said Mangia, speaking at St. John’s Avalon clinic in South L.A.. “We did a tremendous amount of advertising, social media, text blasting to just really drive up the vaccination rates.”

Two men -- one African American and the other white -- talk while wearing masks at St. John's Avalon Clinic in South L.A. The African American man is gesturing with his right hand.
St. John's outreach coordinator Gary Po, left, talks with CEO Jim Mangia at the Avalon Clinic in South L.A.
(Jackie Fortiér)

Usually, clinics such as St. John’s get reimbursed for the cost of each Medi-Cal patient’s visit. But if a clinic staffer gives an individual the shot at a mass vaccination site, there's no way to bill for the single immunization because no other service is provided.

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St. John’s is owed more than $6.5 million for administering the vaccine to Medi-Cal patients — and it isn’t alone, Mangia said. The Community Clinic Association of L.A. County estimates health centers may be owed tens of millions in reimbursement dollars, though the exact amount is unclear.

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

The situation is “very disappointing," said Mangia. "We started doing widespread community vaccinations in January 2021. It’s now 2022 and we haven’t received a single dollar. What’s going on?”

A masked woman fills out a form at the check in counter of the St. John's Avalon clinic in South L.A. A masked employee sits behind the counter, using a computer.
Community clinics like St. John's are subsidized by the federal government and provide care regardless of a person’s ability to pay,
(Jackie Fortiér)

Reimbursement Money Still In Limbo

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The federal Centers for Medicare & Medicaid Services asked the California Department of Health Care Services to work with providers to devise a payment formula estimating how much it costs a clinic to administer a COVID-19 immunization. The average cost they settled on was about $67 per shot.

“We wrote letters back in September to both the administrator for CMS, as well as to the director for the [California] Department of Health Care Services, asking for this issue to get resolved,” said Barbara Ferrer, director of the L.A. County Dept. of Public Health. “You can’t really have getting everybody fully vaccinated as a linchpin of recovery efforts and then not be able to pay the most essential providers in the hardest hit communities.”

Ferrer asked in those letters that the reimbursement plan the agencies devised be approved quickly so the clinics could be paid. That was six months ago. She hasn’t heard back.

“My hope is that it gets resolved," she said. "Otherwise I think the problem is bigger than just saying they may have to curtail what they are doing around vaccines.”

Ferrer fears community clinics may not embrace mass vaccinations in the future because they’ve been forced to wait more than a year for COVID-19 vaccine reimbursement.

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“Hopefully the fix is permanent and doesn’t require everybody to file for this alternative payment methodology every single time you have something that varies slightly around the administration of a vaccine,” she said.

A spokesperson for the Centers for Medicare & Medicaid Services said California’s application is still being reviewed. If it is approved, the health centers will be paid retroactively, though the agency did not provide a timeline.

“In the middle of a pandemic, where you have all the disproportionalities that we’ve seen play out in poor communities and Black and Brown communities, not to be able to pay these folks seems more than misguided," said Ferrer. "It seems unconscionable."

A sign in English and Spanish directs patients to the check-in counter. A woman in a black-and-red plaid jacket and brown pants has her back to the camera as she waits to register. A masked employee can be seen sitting behind the counter.
Without the reimbursement from the federal government, St. John's will no longer be able to offer vaccine-only clinics.
(Jackie Fortiér)

L.A. Vaccine Clinics Could Close In April 

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," said Mangia, who noted that "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."

Now the money is running out. More than a year of paying for medical personnel to give the shots, as well as for security and even masks and gloves, has added up, and Mangia said St. John’s is at its breaking point. Without the reimbursement, he warned, some of St. John's vaccine clinics will close April 1, and 200 workers will be laid off.

“We have a whole plan come April for the pediatric vaccine, in partnership with school districts around the county, so all that will be shut down,” Mangia said.

That would include closing two vaccine sites at Compton Unified and six at L.A. Unified schools that are currently giving shots.

Young children under 5 may become eligible for the vaccine in April, when federal health authorities are scheduled to review the data and could approve the shots for that age group.

Gary Po, outreach coordinator at St. John’s, said closing vaccination sites could hurt the area’s health in the long term.

“Once we get people in with the vaccines, we’re able to talk to them about more things that they may need so it only opens up the door for preventive care,” Po said. “And that’s what St. John’s is here for.”

What questions do you have about the pandemic and health care?
Jackie Fortiér helps Southern Californians understand the pandemic by identifying what's working and what's not in our health response.