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Photo by Sean Dreilinger.

Last winter, Oklahoma’s community health centers (CHCs) received some unwelcome news. A state fund for cover uncompensated care had run dry seven months early. Community health centers, which are among the very few places that low-income Oklahomans can get care regardless of ability to pay, struggled to cut costs without cutting essential services until the state fiscal year ended in July. 

This year, CHCs calculated that they would need $9 million to cover fiscal year 2015 uncompensated costs.  But by the time the budgetary dust settled, CHCs were allocated just $2.55 million – less than one-third of what they’d asked for, and even less than the $3.12 million FY 2014 funding that ran out before half the year was over.

It’s not enough.

In 2013, CHCs in Oklahoma provided care to 162,871 people – a 20 percent increase since 2011 alone. Four in ten were uninsured, and 68 percent were at or below the federal poverty level. Three in ten were children. These are not people who typically have other options when seeking medical care. Without funding to provide uncompensated care, providers have eliminated or severely restricted dental services and mental health care – already harming patient health. They are now considering more drastic measures, such as limiting clinic hours or closing satellite locations, that will completely eliminate access to affordable health care for many Oklahomans.

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John Silva, CEO of Morton Comprehensive Health Systems, says that the state’s CHCs are in survival mode, struggling to preserve their commitment to medically underserved populations while staying in business. “You can only cut expenses so far while remaining viable,” he said.  Eighty percent of Morton’s costs are salaries, so it’s very hard to cut costs further without layoffs.

“If this continues for 24 months,” Silva said, “I doubt you’ll see [any of us] left standing.”

One option Morton is considering is a cap on uninsured enrollment, which could keep them afloat but would leave hanging Oklahomans who don’t make the cut. Closing sites is a last resort, but one they may have to consider. If it comes to that, Silva says, the state’s smaller CHCs won’t survive: a CHC that has 6 or 8 locations may be able to downsize to two or three, but a health center with only one or two locations has no downsizing options.

VarietyCare, another Oklahoma CHC, already closed a location in Tipton, a small town in southwest Oklahoma. VarietyCare CEO Lou Carmichael described that as the “least-painful option.”

“The biggest demand is urban,” she said. “But the biggest need is rural.”

The Tulsa-based Community Health Connections has shut down behavioral health services, cut dental services down to two days a week, and released a care provider and administrator. “We cannot sustain this hemorrhaging of cash,” said Community Health Connection CEO Jim McCarthy.

If this continues for 24 months, I doubt you’ll see [any of us] left standing.”

Closing clinics and limiting services is undoing many investments Oklahoma had made to improve public health. As we’ve previously noted, Oklahoma specifically invested in growing the number of community health centers, and the number of patients seen at these facilities has increased by more than 50 percent since 2007. The cuts to uncompensated care threaten to undermine that investment – and damage the health of the thousands of Oklahomans who have come to rely on CHCs for essential care.

The impact of undermining community health centers’ solvency goes beyond the uninsured. For example, CHCs reducing their hours of operation and eliminating dental services impact all patients. CHCs are highly efficient care providers that consistently outperform other providers in their health care bang for the buck. But when funding cuts force CHCs to cut hours and services, CHCs become less effective at delivering care to all of their patients. 

The shrinking uncompensated care fund is just one part of a disturbing trend of Oklahoma whittling away the health care safety net. Earlier this year, the state hiked Medicaid copayments to the federal maximum and cut Medicaid provider reimbursements. Meanwhile, the state has continued to refuse to accept a massive infusion of federal funds to extend health coverage to low-income Oklahomans. Accepting the funds would save the state more than $200 million in uncompensated care costs alone over the next decade — yet even as we refuse this help, we’re digging our uncompensated care hole deeper.