W.Va. Free Health Clinics Asked to Do More with Less

Apr 8, 2015

West Virginia has been plagued for the past few years with budget deficits. To deal with the shortfalls, the governor has cut state agency budgets across the board, implemented hiring freezes and dipped into the state’s Rainy Day Fund.

This year, Gov. Earl Ray Tomblin cut the House and Senate approved budget by an additional $11 million, leaving some service programs to wonder how they’ll keep their doors open. The Charleston Health Right is just one of those service programs.

The West Virginia Health Right clinic located in Charleston's East End is a free and charitable clinic that provides medical, dental and vision services to more than 15,000 uninsured and underinsured West Virginians each year. 

Beginning July 1, 2015, though, the Charleston clinic, along with nine other clinics across the state, will see a significant reduction in their budget. Executive Director Angie Settle said the cut for her location will be nearly 33 percent.

After two years of 7.5 percent across the board cuts from  Tomblin, Settle's location will have 48 percent less funding than three years ago. Settle said they've looked to cut waste wherever possible, but there is little left to find.

Because of the clinics' ability to bill Medicaid, something the Charleston clinic began doing in January 2014,Tomblin said in his veto message those clinics should be able to recover part of the money cut. 

But Settle said that statement just isn't true for her clinic. In 2014, her clinic brought in $188,000 from Medicaid billing, but spent nearly $100,000 on a person to do the billing and the software and IT upgrades to make it possible. 

Settle said even though the start up costs are complete, Medicaid billing won't make up for her 2016 33 percent budget cut for two reasons. First, because of notoriously low Medicaid reimbursement rates, and second because of the population she serves.

Executive Director of West Virginia Health Right Angie Settle.
Credit Ashton Marra / West Virginia Public Broadcasting

"More than half of the patients we see are the working poor," she said. "West Virginians with two and three jobs."

Medicaid allows clinics to bill for some services, but Settle said they often won't reimburse multiple services that occur on the same day. Because she serves a population who may be prohibited from going to multiple appointments because of their work schedule, child care, or ability to pay for transportation, Settle said her patients just won't return for multiple appointments.

“It reminds me of almost like a NASCAR pit stop when people come here. We [do] everything we can do for them that day. Talk to them about smoking cessation, dental health, get their blood pressure checked, get their blood work done, get their pap smear if its due, give them a slip to go get a mammogram. Everything we can pack into that visit, as much bang for the buck in that day," she said of their philosophy of care.

Sometimes Medicaid will cover one or all of those services, and sometimes they won't, Settle said, but she doesn't see that as incentive to change the way they serve their population, 50 percent of which have Medicaid coverage and 50 percent of which have no insurance at all.

“By squashing funding to free clinics and saying we don’t want to fund free clinics, it basically tells the people of West Virginia, the working poor, we want you to quit your job so you can get on Medicaid," she said. "It says we don’t want you to work. We want you to quit your job and get on Medicaid or go without.”

Senate Finance Vice Chair Chris Walters said he and his fellow lawmakers tried to work with the clinics to get their line item appropriations in a workable range, knowing the governor intended to make cuts. He said he understands the importance of the clinics to their communities, but lawmakers had to make tough choices to balance the overall budget.

Walters said the state is expecting another budget deficit in 2016, but said lawmakers are working to come up with ways to increase revenues.