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Stimulus Boost Health Clinics’ Budgets in Massachusetts

New America Media/Brazilian Journal, News report, Marcony Almeida Posted: Feb 18, 2010

Editor's Note: This story, which originally appeared in the Brazilian Journal, was produced as part of NAM's Stimulus Watch coverage and was funded with a grant from the Open Society Institute.

Maura Smith wept when she learned that the Lowell Community Health Center was granted $9.35 million from the American Recovery and Reinvestment Act (Recovery Act). The health center has been in existence for 37 years in Lowell - a city with one of the highest unemployment rates in Massachusetts, at almost 12 percent.

Lowell is one of the most diverse cities in the Commonwealth with 14 percent of its population foreign born. For many immigrants in the city, the health center is the only resource to access health care. Eight Massachusetts community health centers, which deliver care in some of the poorest neighborhoods in the state, are receiving $80 million in federal stimulus cash to expand old buildings and upgrade technology.

For the state, it was an impressive haul: Roughly one of every eight dollars that the federal Health Resources and Services Administration committed to community clinics is bound for Massachusetts. The state is the only one in the country with mandatory universal health care but government figures show that minorities still have problems accessing health care and rely on neighborhood health centers to see a doctor. “In 2008, we saw 32,000 patients in our facility, a third of Lowell’s population, but we could see 10,000 to 12,000 more if we had more exam rooms and staff,” said Smith, who is the director of development and external relations of the Lowell Community Health Center.

And that’s exactly what the stimulus money will do for the Lowell health clinic – allow it to hire more people and expand its facilities. The center has 290 employees, including medical providers, nurses and other staff but the $9.35 million expected from the stimulus will add 100 more permanent jobs in different positions and create 198 construction jobs.

“We have been applying for grants for the past 10 years to expand our building and hire more people, especially after the state’s universal health care law in 2006. But we haven’t been able to reach our $30 million project goal,” Smith said. The stimulus is only a third of the money needed for the construction of the new building, but the director remains hopeful because after the center obtained the competitive stimulus grant, she believes it will be easier to get other federal money.

The money provided by the stimulus is a one-time award but it will be exactly what the Lowell clinic needs to expand its services and bring more financial stability. “Health centers make money via reimbursement from the federal government through Medicare-Medicaid and private insurances,” said Smith. “That’s why we are different agencies from shelters, food banks and others. We have financial stability. So the more patients we treat, the more reimbursements we receive. That’s why even though we won’t see $9.35 million from stimulus next year, by expanding our facilities now we'll be able to be better financially established.” Around 70 percent of the clinic’s income comes from reimbursements; the rest comes from grants and fundraising.

“Oh my God! Are you serious? This is great news because I know that I had to wait up to three months to see a primary care doctor because of the wait list,” said Maria da Gloria, a patient at the Lowell Community Health Center, after learning about the grant and the clinic’s expansion projects. Da Gloria, a Brazilian immigrant who has been living in Lowell for 15 years, depends on the clinic’s care to treat her diabetes.

Many of the health centers long ago outgrew the space cobbled together over the years as they treat patients stricken with conditions that have become more common, including asthma and diabetes.

And the number of patients seeking care has only grown since the overhaul of the state’s health care system, which provided thousands of uninsured patients with coverage, but with no guarantee of an appointment with overburdened primary care doctors. It’s a conundrum evident on an hourly basis at the community health centers, especially those serving mostly minority communities with immigrants. Seventeen percent of Massachusetts’ population is foreign born.

Lowell Community Health Center is over an hour away from Boston. More than half of the $80 million in stimulus money awarded to state clinics - about $42.5 million - is destined for Boston. The biggest grants, $12 million each, were awarded to Whittier, the East Boston Neighborhood Health Center, and Healthfirst Family Care Center in Fall River. The fourth Boston clinic getting money is the Dorchester House Multi-Service Center that will receive about $7 million. The other recipients are Community Health Connections in Fitchburg ($10.7 million), and Greater New Bedford Community Health Center ($5.3 million).

“We are thrilled because we’ve demonstrated through quality of our care, clinic outcomes… that we are a good investment,” said Whittier Community Health Center President/CEO Frederica M. Williams. With the stimulus grant, Whittier will build a new permanent facility in Roxbury, one of the poorest neighborhoods of Boston. The new construction – a $32 million, 78,000 square-foot facility - will create 50 permanent jobs and 450 construction jobs. “We will be able to see over 5,000 new patients a year with our new facility.”

Similar to the Lowell Center the money coming from the stimulus will not be the only solution for other state health center needs. The grant was a boost to these clinics that have been trying to raise money to expand their facilities for years. “Our project costs $32 million and the stimulus brought us $12 million. But, the rest of it we will secure with fundraising and other pending grants,” explained Frederica M. Williams with theWhittier Community Health Center. “Our new facility will bring more financial stability by being able to see more patients.” It is a similar situation faced by the Lowell Community Health Center.

Governor Deval Patrick, who has been criticized by his opponents for using the money from ARRA awarded to Massachusetts too slowly, credits the big chunk of money that the health clinics received to his relationship with Kathleen Sebelius, secretary of Health and Human Services in the Obama administration and to the state’s federal delegation in Congress. But, the money was not part of the $4 billion that the state received from ARRA. In an interview with ethnic media reporters, Patrick said that Massachusetts stimulus money has helped minority communities in several programs, but not specifically through community health centers. He couldn’t specify which programs that serve these communities received funds, when questioned by The Brazilian Journal Magazine.

"The Executive Office of Health and Human Services have been awarded $22.7 million in ARRA grants through different departments. Most of this money goes to minority communities, but there is not data on which specific programs they have affected,” said Dayanne Leal from the think tank Health Care for All. Jordan Corizan, from the Executive Office of Health and Human Services said that the funded projects assist disadvantaged populations in securing or retaining employment, providing resources to expand and support local public health infrastructure, and delivering a range of support resources for families hardest hit by the recession. The Department of Public Health, Executive Office of Elder Affairs, Department of Transitional Assistance and the Massachusetts Commission for the Blind are among the state agencies who have received funds from ARRA to assist disadvantage communities, mostly people of color and immigrants.

The communications director for the Health Resources and Services Administration, Martin Kramer, described the competition for the stimulus cash as tough, with barely one in six clinics that sought cash receiving it. “It wasn’t that there was anything specific about Massachusetts,’’ Kramer said. “It was that these individual health centers made very compelling arguments as to why they needed this funding and how it would benefit the communities they serve.’’

Boston is the birthplace of the community health center movement. In December 1965, at the height of the nation’s so-called war on poverty, a clinic opened in Columbia Point, placing the city at the forefront of a crusade to bring medical services to neglected urban neighborhoods.

“Community health centers are unique models of investment in the health care arena, especially during economic crises,” says Maura Smith. “We have preventive programs that result in a health community, so less cost for everyone.”

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