As Medicaid Shrinks, Clinics for the Poor Are Trying to Survive

Those health centers have each seen revenue losses of at least $500,000 because of the Medicaid unwinding, according to Amy Simmons Farber, a spokeswoman for the health center association.

By the end of December, Family Health Centers, a network of clinics in Louisville, Ky., had lost more than 2,000 Medicaid patients since the policy change took effect in April, an almost 6 percent decline, said Melissa Mather, a spokeswoman for the clinic. For every percent decline in Medicaid patient visits, she said, the clinic experiences a revenue decline of $175,000 to $200,000.

Bethesda is now engaged in a “month-to-month game of survival,” said Amber Greene, Bethesda’s operations manager, who also works as a nurse. Standing in a supply closet to make her point, she gestured to a modest stash of Tylenol, Motrin and thermometers, which the church next door had donated.

The clinic, with the vast majority of its patients on Medicaid, needs roughly $115,000 each month to operate its medical and dental clinics, but still runs a monthly deficit of around $10,000. Sometimes the costs it eats are small, such as the fee for the shot Dr. Price administered to the mother who could not pay. But they add up, forcing the clinic to get creative to preserve funds. A local pharmacy offers substantially discounted antibiotics, and the clinic cut the costs of its virus tests by conducting them in-house.

Texas health officials have defended the unwinding as a natural reversion to Medicaid’s intended shape and size. Conservative health policy experts have also argued that shrinking the rolls is important to sustaining the program financially.

“The reality is that many health professionals cannot sustainably see Medicaid patients because the program reimburses so little, and the claims process is so excruciating, many providers end up taking losses to the point it threatens closure,” said Tanner Aliff, a health policy expert at the conservative Texas Public Policy Foundation.