To the Editor:
If you have commercial health insurance and have always had that coverage, you may not have considered the significant challenges faced by individuals living below the poverty line in accessing affordable, quality primary health care. The stark disparity between the experience of commercially insured individuals and those from marginalized communities is unacceptable. While those with commercial insurance can typically schedule a physical exam within two weeks or get same-day care for acute issues, individuals relying on Federally Qualified Health Centers (FQHCs) often face a wait of three months for a routine check-up and several days for acute care.
FQHCs serve a vital role in providing primary care for vulnerable populations. These centers offer comprehensive services, including primary care, OB/GYN, behavioral health, and dental services. Many also provide specialty services such as nutrition, podiatry, acupuncture, chiropractic, and vision care. FQHCs ensure culturally competent, high-quality, and affordable care, using a sliding fee scale for uninsured patients. They also offer essential wraparound services, such as Medicaid enrollment assistance and help navigating the social determinants of health that can be barriers to care.
These centers rely on Medicaid funding to cover operational costs and provide care for uninsured patients who are ineligible for Medicaid. However, Connecticut’s Department of Social Services (DSS) has not increased or rebased Medicaid rates in 23 years, paying significantly less than neighboring states like New York and Massachusetts. This chronic underfunding creates severe consequences:
- Reduced Access to Care: Inadequate reimbursement forces FQHCs to cut costs, often by reducing staff. This results in fewer available appointment slots, longer wait times, and decreased continuity of care. Patients, unable to access timely care, may delay treatment until their condition becomes critical, leading them to seek emergency department care—an expensive and inefficient alternative.
- Staffing Challenges: Underfunding makes it difficult for FQHCs to recruit and retain clinicians and support staff. Competing against hospitals and private practices that offer higher salaries, FQHCs struggle to fill vacancies, leading to overburdened staff and further reductions in access to care.
- Deteriorating Facilities and Equipment: Limited funds prevent FQHCs from renovating facilities, performing necessary maintenance, and acquiring modern equipment that could improve efficiency and patient outcomes.
Moreover, the underfunding and lack of a proper rate rebasing process, that violates federal law, is why the state’s community health centers have been left with no choice but to start legal action against DSS. The goal is to create a process for changing rates that complies with the law and provides financial sustainability for community health centers like Optimus.
Optimus Health Care, Inc., an FQHC serving 43,000 people and with locations in Bridgeport, Stratford, and Stamford, faces these challenges daily. We receive $80 less than our actual cost per Medicaid visit. This forces us to reduce staff and leave clinician positions unfilled for months. Patients wait months for appointments, struggle to see their primary care providers due to frequent turnover, and experience clinic closures that force them to travel farther for care—an often insurmountable challenge for those dependent on public transportation. Our dedicated staff work tirelessly despite limited resources, but they too suffer from low compensation and lack of modern equipment. While they stay out of commitment to their communities, should we accept a system that undervalues their work and sacrifices?
The message sent by Connecticut’s Medicaid underfunding is clear: health inequity is acceptable. By failing to support FQHCs adequately, we perpetuate disparities in access to primary care, worsen health outcomes, and drive up overall healthcare costs. This is not just a financial issue; it is a moral imperative. Medicaid rates should not be viewed as mere budget line items but as lifelines for those in need and the professionals who serve them. Health care in Connecticut must be recognized as a fundamental right, not a privilege tied to socioeconomic status. It is time to properly fund FQHCs with fair, cost-based Medicaid reimbursement to ensure their sustainability and the health of our most vulnerable communities.
Karen Daley is the Chief Executive Officer of Optimus Health Care which operates thirty health centers, including school-based sites, throughout Bridgeport, Stratford, Milford and Stamford.