Community health centers in Medicaid expansion states have seen significant improvements in financial stability and the ability to provide affordable care to patients since the Affordable Care Act compared to non-expansion states, according to a new report from The Commonwealth Fund. More than two-thirds of community health centers in expansion states reported improved finances since the ACA compared to 41% of those in non-expansion states.
Health centers in expansion states were also more likely to offer value-based contracting, medication-assisted treatment for opioid addiction, behavioral health counseling and coordinated care with help from social service providers.
However, expansion states were also more likely to report unfilled job openings for mental health professionals and social service providers, according to the report.
The study authors warned that if Congress doesn't renew federal funding for health centers, gains in the three dozen expansion states could be lost.
More than 11,000 community health centers spread across the country provide primary care to slightly less than 10% of all Americans. They offer a safety net for low-income and uninsured people, many of whom have chronic illnesses or are at greater risk of those health problems.
Community health centers also help keep patients, including uninsured people, out of hospital emergency departments. Getting that care in an emergency room is more costly and can cause access issues for others who need emergency care.
The report was overwhelmingly positive about Medicaid expansion, with one exception: the staffing shortfall in Medicaid expansion states, which authors linked to higher demand. Areas looking to expand the program will want to explore their staffing situation and seek ways to increase the number of behavioral health professionals or find other solutions, such as expanding telehealth.
The Commonwealth Fund report comes as non-expansion states are exploring whether to expand Medicaid, whether partially or fully. Utah recently sidestepped voters, who supported a full expansion, and got the OK from CMS for a partial plan that will cost Utah more than if it went with a full expansion, and will cover fewer people.
Other right-leaning states are looking to possibly follow suit. The courts may ultimately decide whether those restricted expansion plans work. A federal judge already turned aside Medicaid work requirements in Kentucky and Arkansas.
Of course, there's also the issue of the Department of Justice backing a plan to kill the ACA. Doing so would eliminate Medicaid expansion, which provides coverage to about 15 million Americans. Removing that coverage option for lower-income people will lead them to lose coverage, hospitals will face more uncompensated care and community health centers may have worse finances. All of those factors will result in poorer health coverage and care.