Louisiana’s new Medicaid waiver to finance free health clinics

This article was published in The Hullabaloo on September 24, 2010.

The U.S. Department of Health and Human Services approved a Medicaid waiver to the state of Louisiana Wednesday that will free up funds typically allocated only to hospitals to help fund New Orleans’ 87 community health clinics.

The typically-free clinics, which were established after Hurricane Katrina, have been funded primarily by rebuilding grants, including a substantial amount from Qatar and a $100-million federal Primary Care and Access Stabilization Grant that is set to expire Thursday.

The newly approved Medicaid waiver will provide $97.5 million to fund the primary-care clinics during the next three years, though the clinics will still have to raise funds independently as well.

“These Community Health Clinics are neighborhood anchors that support one in five residents of the Greater New Orleans area and provide valuable health services to a large proportion of working families and the uninsured,” Senator Mary Landrieu said in a press release Wednesday. “These clinics represent an innovative approach and a new model for health care delivery.”

The community health clinics aim to cut skyrocketing healthcare costs by providing primary care to uninsured residents who otherwise must visit the emergency room. Avoidable emergency room visits accounted for $3.5 billion in 2006, according to a study by the National Association of Community Health Centers, Inc.

“We’ve been able to show a model for healthcare that’s been an inspiration on a national level,” said Ashley Wright, a social worker and program manager at one of Tulane’s mobile community health clinics. “We are showing the country that neighborhood clinics can keep people out of the emergency room and, that way, reduce healthcare costs across the spectrum.”

With national healthcare reform set to go into effect in 2014, the New Orleans model has showcased ways to cut costs while still providing high-quality universal healthcare.

“The general stigma is that if you’re getting care that you don’t have to pay for, or without paying insurance, then it’s probably not the best care that you’re receiving,” said Chukwunomnso Dennar, the physician on site at the Tulane mobile clinic, who is also a member of the Tulane School of Medicine faculty and practices at the Tulane Hospital.

“We can do a lot here, but we can’t do everything,” Dennar said. “But a lot of people don’t need everything. It’s much more efficient.”

A study done by Avalere Health for the National Association of Community Health Centers found that, on a national scale, community health centers save between $9.9 and $24 billion annually by preventing avoidable emergency room visits and causing fewer, shorter hospital admissions.

“Financially, it’s a better investment to invest in people in the community before they get sick,” said Leah Berger, director of community health programs, planning and development at the Tulane School of Medicine. “And morally, we know how to prevent a lot of these diseases, but we shut the door on people because they don’t have insurance.”

“I would be very poor if I had to pay for a doctor, and pay for my diabetic supplies,” said Cherie Polle, a 62-year-old patient at the clinic who is just above the eligibility for Medicaid. “I would have to be on food stamps. The medications I get for free would be costing me about $100 a month, maybe more.”

Aside from doctor appointments, the Tulane mobile clinics also periodically offer free screenings outside Winn-Dixie or Walmart, where medical staff can check approximately 100 people in one day for determinants of preventable conditions, such as blood pressure, diabetes, cholesterol and heart rate problems.

“Universal healthcare doesn’t work without everyone seeing a primary care physician,” said Jon Custodio, a graduate student in the Tulane neuroscience department who has worked with the Louisiana Justice Institute, Federation for Historical Louisiana and Organization to Save Charity Hospital. “It’s a broken system until that happens.”

Custodio said that U.S. healthcare should use this model to achieve universal healthcare in the future.

“New Orleans is one of the sickest cities in the country,” Custodio said. “If this model works here, it’ll work anywhere.”