Colorado clinics scramble to find place in new health care environment

Posted: 05/01/2014 12:01:00 AM MDT

Free and low-cost clinics around the metro area are scrambling to find their place in light of the Affordable Care Act and expansion of Medicaid.

Some clinics that previously served only people without insurance are preparing to take Medicaid and even private insurance. Others are sticking with their mission of serving residents who don't qualify for insurance, even as that number dwindles.

'Our mission is to serve underserved folks,' said Tracy Pineda, director of health promotion at Clínica Tepeyac in Denver. 'We're not opening up a Medicaid clinic. We're not opening up to see everybody and anybody.'

Despite having no plans to treat the patients, Clínica Tepeyac staffers have been helping clients who qualify for Medicaid or subsidies for private insurance to sign up through Colorado's health exchange. Pineda expects that most clients, who pay about $25 a visit for services, to be undocumented residents who don't qualify for Medicaid or private-insurance subsidies.

'One of our main requirements is that clients not have any health insurance,' she said.

The current Medicaid caseload in Colorado is more than 900,000 people and is expected to exceed 1 million - or about one-fifth of the state's population, according to the Colorado Department of Health Care Policy and Finance.

There are approximately 1,200 publicly funded health centers nationwide that provide care to patients regardless of their ability to pay, according to the U.S. Department of Health and Human Services. They range from large hospitals such as Denver Health Medical Center to smaller clinics.

Small health clinics typically rely on a mix of funding that includes private donations, patient fees and government grants, although some independent clinics don't receive government money. The Affordable Care Act earmarked $11 billion to be spent over five years to support community health centers and create new ones in underserved areas.

In Littleton, Doctors Care is planning for an influx of people with Medicaid who may not be able to find care from other doctors.

'As a safety-net provider, we don't want to be in the position of competing with private physicians,' executive director Bebe Kleinman said.

In anticipation of an increase in Medicaid patients because of state and federal expansion laws, Doctors Care expanded its patient capacity.

'We have room for more patients, and we made that decision several years ago,' she said.

And providers will benefit from the additional federal money coming into the clinics.

'We see it as a real positive,' Kleinman said. 'Some payment is better than no payments or very, very low payments.'

At Denver's Inner City Health Center, managers plan to accept all patients whether they pay out of their pocket, have Medicaid or have private insurance.

'We will still care for you, regardless, without interruption of service, no matter what coverage you have,' said Inner City CEO Kraig Burleson. 'You won't have to change doctors, no matter what coverage you have.'

Burleson said about 80 percent of Inner City's patients have no coverage, and he expects that to drop to about 65 percent by 2015 or 2016 as Medicaid expands and people sign up for private insurance. Projections show about 25 percent to 30 percent of Inner City patients will have Medicaid and the rest private insurance.

'The vulnerable and at-risk populations still need a place to go,' he said.

Despite sticking to its mission of helping only people with no insurance, Clínica Tepeyac has not yet seen a noticeable decrease in patients. But it is still early in the changeover to the Affordable Care Act.

Pineda said there are no plans to serve insured or Medicaid patients, but she concedes that that could change as hospital staffers understand what ACA changes mean for the clinic.

'We have had to sit and talk about whether to accept Medicaid folks, and it may happen in the future,' she said. 'At this point, ... it is easier serving people who most need it.'

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.