Federally qualified health centers, also known as , act as a safety net for uninsured and under-insured patients.
But in Texas, the clinics face more challenges because the state hasn鈥檛 expanded Medicaid. That leaves almost , according to the Kaiser Family Foundation.
What would it mean for these clinics and the communities they support if Texas increased health care eligibility?
What are FQHCs?
Federally qualified health centers, or FQHCs, are nonprofit primary and preventative care clinics that take all patients, regardless of their ability to pay. There are close to across the United States, and in both rural and urban communities.
鈥淲e are the family doctor,鈥� said Leonor M谩rquez, CEO of the LBU Community Clinic in Dallas. 鈥淭hat's probably the easiest way to describe it.鈥�
, and now has five locations around the city.
鈥淲e started very humbly,鈥� M谩rquez said. 鈥淲e started in two portable trailers, and we have grown to where we鈥檙e almost 100,000 square feet of clinics throughout Dallas.鈥�
Jana Eubank, the executive director of the , said FQHCs adapt to the communities around them.
鈥淲e've learned that a person's zip code and income level often is a bigger predictor of their health outcomes than even their genetics,鈥� she said. 鈥淎nd so, our model of care also includes connecting our patients to other needs that they have in the community.鈥�
Eubank said clinics screen people for the 鈥� non-medical experiences and systems that impact people鈥檚 health outcomes. Those could include food insecurity, housing insecurity, unemployment, transportation access and income. Clinics then connect people with community partners to address these issues.
鈥淲e really try to connect everyone [to] all the services that they can get in the community,鈥� Eubank said, 鈥渂ecause you're really at a disadvantage if you're uninsured in the state.鈥�
What kinds of patients do community health centers serve?
A majority of FQHC patients in Texas are uninsured, or have Medicaid or Medicare coverage, according to the .
Joleen Bagwell, the chief development officer for LBU Community Clinic, said they see about 27,000 patients a year. More than half of their patients are uninsured, about 3% of patients have private insurance, and the rest have Medicaid or the .
The latest census data show that 18% of Texans are uninsured. That is as if everyone in didn鈥檛 have health insurance. One reason many Texans are uninsured is the state has yet to expand Medicaid to low-income working adults.
About fall into the insurance coverage gap, where they make too much to qualify for Medicaid, but not enough to afford other kinds of insurance.
M谩rquez said not having insurance puts a strain on a patient鈥檚 ability to access care.
鈥淭he number one and two killers in this community here in West Dallas are ,鈥� M谩rquez said. 鈥淭he difference is people are dying 10 and 20 years earlier [here]. That speaks volumes for health insurance, access to a doctor, safe communities.鈥�
Both adults and kids without insurance have worse health outcomes. , and kids without insurance were and not receive medical treatment for .
What challenges do community health centers face?
Services
Terri Sabella is the CEO of , an FQHC with clinics all over the greater Brazos Valley. She said about a third of their patients 鈥� primarily pediatric patients 鈥� have Medicaid coverage, and a little less than a quarter are uninsured.
When uninsured patients come to the clinic for care, it鈥檚 often after an emergency room visit or a serious health complication, Sabella said.
鈥淪ometimes there's already organ damage by the time we're caring for them,鈥� she said. 鈥淪ome of them may even have known that they had a chronic disease like diabetes or heart disease, but they weren't able to consistently take their medication because of the cost of the medication.鈥�
She said it makes treating patients more challenging, because people may need more intensive care than the clinic offers. A quarter of patients that visit FQHCs need referrals to specialists, but 鈥渇ewer specialists are participating in the care of vulnerable populations, and there is no clear system for patients or primary care physicians to access those who do provide care,鈥� according to a study from .
Specialty care doctors often don鈥檛 take Medicaid patients because of in comparison to private insurance patients. Before 2023, Texas had not increased Medicaid payments in more than a decade, but this year for labor, delivery, and pediatric visits.
But doctors still to take patients without insurance or even with Medicaid. That leaves clinics like LBU and HealthPoint having to cobble together 鈥渁n informal network of specialty providers that are willing to see someone,鈥� said Jana Eubank with the Texas Association of Community Health Centers.
鈥淟et's say we have a patient that we screen, and she has breast cancer,鈥� she said. 鈥淲e don't provide oncology services; those are specialty care services. So, we try to use our friends and call-in favors from other providers to be able to see our patients. But we can鈥檛 always swing that or there's often not providers that are willing to do that.鈥�
Without access to specialty services, 鈥渦ninsured adults with cancer are diagnosed at more advanced stages of disease, have poorer outcomes, and die sooner, even after adjusting for stage of disease,鈥� according to This is also true across other chronic illnesses like diabetes, heart disease and hypertension.
Funding and recruitment
Because such a large percentage of patients coming to FQHCs are uninsured, clinics work on 鈥渞azor-thin financial margins,鈥� Sabella said.
While she said clinics are grateful for federal funding from the Health Resources and Services Administration (HRSA) and some , it often doesn鈥檛 cover the total cost of operations.
Leonor M谩rquez from LBU Community Clinic in Dallas said the more uninsured patients there are in the state, the greater the financial strain is on clinics helping them.
鈥淚magine the uninsured adult that comes in, we might collect $30, $40, when the care will cost $350,鈥� she said. 鈥淲hat it means is that's uncompensated care. We're happy to see them, but paying for the doctors, paying for the facility, paying for overhead, paying for the support staff, it just makes it all the more difficult.鈥�
The clinic has close to 300 employees who are committed to their work, but 鈥渢hey're also just folks trying to pay their bills and struggle with inflation and gas prices, just like everyone else in this community,鈥� she said.
At HealthPoint, Sabella also said the state鈥檚 lack of Medicaid expansion has impacted staffing.
鈥淲e recruit on a nationwide basis, and [providers] might be reluctant to join organizations that are running super thin margins, or in states where Medicaid has not been expanded because they might have fear of financial instability,鈥� she said.
Challenges in staffing and finances means clinics often can鈥檛 expand services or locations to keep up with demand, Sabella said. It puts a strain on organizations like HealthPoint, where some locations are the only primary care providers in the community.
Rural communities also may lack access to hospital care and emergency departments because Texas has the highest number of rural hospital closures in the country 鈥� , according to a report by the U.S. Government Accountability Office.
How would Medicaid expansion impact their work and the communities they help?
Overall, said Jana Eubank with the Texas Association of Community Health Centers, Medicaid expansion would improve the financial stability of safety-net clinics, improve access to care services, and expand programs to address social determinants of health, like housing, childcare and transportation.
Leonor M谩rquez in Dallas said many times, clients are making choices between addressing health issues and putting food on the table.
鈥淚 would like to take that out of the equation, that it's not either/or, it's both/and,鈥� she said. 鈥淚f Texas expanded Medicaid, what it would mean is there's thousands and thousands and thousands of adults who will have access to health insurance. It takes away the fear of, 鈥業 hope I don't get sick, I hope I don't get injured on the job, I hope I don't get in a car accident.鈥�
"All of those things are very scary things when you don't have health insurance.鈥�
It would also help the clinic meet growing community needs, she said.
鈥淔or the organization, it means stronger financial health,鈥� she said. 鈥淚t means that we don't have to sweat bullets over the increasing number of patients coming in, and how are we going to pay?鈥�
Terri Sabella with HealthPoint said Medicaid expansion would encourage health professionals to take jobs in the state.
鈥淢edicaid expansion might send a message that there's a commitment to care for the working poor in our communities,鈥� she said. "It might alleviate some of that [financial] concern and draw more of those graduates into our communities.鈥�
Eubank said community health centers are in 137 of the 254 counties in Texas, and Medicaid expansion would help them expand to communities that don鈥檛 yet have care access.
鈥淚t would be a game changer,鈥� she said. 鈥淭he most important thing is, it's the right thing to do for people. I mean, just that peace of mind that you have when you have insurance is huge.鈥�
While Texas lawmakers have yet to significantly advance Medicaid expansion bills, Eubank is hopeful people will understand the urgency of this issue and act.
鈥淚 know a lot of policymakers are interested in this and are looking at this, but we've been a little bit slow to adopt compared to some other states,鈥� she said. 鈥淲e need our legislature, our governor, and our state Medicaid agency to really think more creatively on how to address some of the health care needs that we have in this state.鈥�
Got a tip? Email Elena Rivera at erivera@kera.org. You can follow Elena on Twitter .
四虎影院 is made possible through the generosity of our members. If you find this reporting valuable, consider Thank you.
