By Rachana Pradhan and Rachel Bluth, California Healthline
Community clinics in California say they have not been paid for at least 1 million doses of the covid-19 vaccine given since January, creating a “massive cash flow problem” for some and complicating efforts to withhold the vaccine. staff. Clinics in other states, including Michigan and Mississippi, are also on hold.
The delays stem from the separate way in which federally licensed health centers are reimbursed for care under Medicaid, the joint federal-state program providing health coverage to those on low incomes. Some centers don’t even charge for the shots because they say it’s too complicated.
Clinics owe at least tens of millions of dollars for the injections they have given since the vaccines received emergency clearance.
Of the roughly 70,000 doses administered by La Clínica de la Raza, an organization with more than 30 sites in the Bay Area, almost none of these costs have been reimbursed, said chief financial officer Susan Moore. And clinics do not expect to receive reimbursement for about half of these injections because they were administered to the community without collecting insurance information. Additional staff time and supplies were covered by the grant money.
“We are monitoring our cash flow very closely,” said Moore. “When the pandemic started I was very worried, but by the time the vaccine came out it was clear to me that we were going to have enough money in the short term. “
The Biden administration has relied on the clinics to increase vaccination rates among racial and ethnic minorities and people living in poverty. Health centers have administered nearly 15 million doses of vaccine, federal The data shows, although it is not clear how many of these were given during a visit to a patient.
Under federal law, the government pays health centers a fixed rate for patient visits, each of which can cost hundreds of dollars. Many state Medicaid agencies have stated that if a patient receives a covid vaccine along with other care, the cost of the clinic to administer the vaccine is covered as part of its normal payment rate.
Payment problems arise when the covid vaccination is the only service provided, officials say, such as at a mass vaccination clinic.
During large-scale vaccination events, “we usually administer vaccines without this larger service,” said Philippe bergquist, COO of the Michigan Primary Care Association, which lobbies for health centers.
Some states have told health centers that they can bill Medicaid separately for each dose given in this situation, such as Medicare. Payment level about $ 40 per hit. But others, like Michigan and California, have endured a months-long process with the Centers for Medicare & Medicaid Services to devise a payment formula for how much it costs a clinic to give it a shot.
CMS said it was considering proposals from 13 states to pay clinics for vaccinations. “We are continuing to work with States on their proposals,” said a CMS spokesperson. If approved, clinics would be paid retroactively.
Michigan worked with CMS to determine reimbursement “when these vaccines are administered as a stand-alone service,” said Bob Wheaton, spokesperson for the state department of health. Bergquist said the calculated cost in Michigan was just under $ 40 per dose.
California devised a plan that “meets federal requirements that reimbursement for these clinics is based on the cost of providing the services,” said Carol Sloan, spokesperson for the California Department of Health Care Services.
California’s average cost to provide each dose is approximately $ 67, based on clinical data provided.
Because of the short shelf life of an open vaccine vial, health centers have opted for dedicated vaccination clinics instead of individual appointments, to avoid wasting doses, said Andie Martinez Patterson, vice -Senior president of the California Primary Care Association, which lobbies for state health centers.
The lack of payment is “untenable given the financial constraints of these suppliers and the enormous expenditure of resources during this historic response to the pandemic”, Barbara ferrer, director of the Los Angeles County Public Health Department, wrote in a Sept. 22 statement. letter to CMS administrator Chiquita Brooks-LaSure. In interviews, clinics cited high immunization-related expenses, including running community clinics and targeted social media campaigns.
“There is a tremendous amount of misinformation and misinformation out there,” said Jim Mangia, CEO of St. John’s Well Child & Family Center in Los Angeles, which has opened 26 vaccination sites and operates three mobile units. “You kind of have to do double the work to counter it.”
Angel Greer, CEO of the Coastal Family Health Center on the Mississippi Gulf Coast, said not receiving payment to help cover clinic staff costs was detrimental. Over 50% of the clinic’s patients are uninsured, and 14% each have Medicare or Medicaid. The Federal Administration of Resources and Health Services reimburse separately clinics for vaccines administered to uninsured persons.
In Mississippi, state officials first offers a plan that would have reimbursed health centers at the Medicare rate for stand-alone vaccinations. CMS did not approve it.
“I’m sure the whole country is no different from Mississippi in our struggles to maintain an adequate workforce. It is extremely difficult to be competitive with these labor constraints when we are not being reimbursed for these services, ”said Greer. The health center administered 1,000 doses of the covid vaccine in September, with the “overwhelming majority” occurring without a regular medical visit, Greer said.
By the winter of 2020, it became clear that clinics in California were going to have to shoulder the costs of vaccination for a period of time, Martinez Patterson said. They “prayed in prayer that most of their expenses would be reimbursed,” but continued and vaccinated the patients anyway.
Scott McFarland, CEO of MCHC Health Centers, said his staff at four clinics in rural Lake and Mendocino counties gave 3,500 injections without reimbursement.
“I’m pretty confident we’ll get paid eventually, but that’s one of the downsides of being a community health center,” McFarland said, a sentiment expressed by others. The clinic is still doing injections and he thinks the money will eventually come. “It’s just a matter of timing, I guess.”
Health centers are pulling different pots to stay afloat: The American Rescue Plan Act provided clinics $ 7.6 billion to support vaccination, testing and treatment for covid. The clinics relied on small business loans from the Paycheck Protection Program, as well as state money, for immunization efforts. “I think because of the federal help, there is no fire,” Martinez Patterson said.
Health centers in other states have echoed this.
“We have no problem with the refund,” said Dr. Andrea Caracostis, CEO of the Hope Clinic in Houston. She noted that the federal government paid for the vaccines and that some health centers’ payment rates cover the vaccines.
Fifty-one federally approved health centers in California earlier this year reported unpaid claims for 1 million doses. The actual total is probably higher; California has 188 health centers.
“We do not consider this small subset, or the data provided, to be sufficiently representative” to accurately estimate the extent of unpaid immunization claims, Sloan said.
California health centers administered 4.8 million doses, according to federal data.
“We’re just reducing it,” said Mangia of St. John’s.
St. John’s plans to be reimbursed for Medicaid doses in November or December, the clinic said through a spokesperson.
“We know they’re good at it. We know it happens ”, Louise mccarthy, CEO of the Los Angeles County Community Clinic Association, said about Medicaid payments. “But it’s really hard to hire people when you don’t have the cash. “
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operational programs of KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.