I have migrated late in my medical career to working part-time in a Federally Qualified Health Center. (FQHC…sorry but the anagrams may start piling up.)

These centers grew out of a 2001 plan from President George Bush II. He wanted to improve access to primary care in underserved communities. Back in 2000, 14% of our country’s population was uninsured. There was back then, and is now, plenty of evidence that access to primary care improves community health.

 I guess back then even Republicans were comfortable solving our national healthcare problems with federal programs.  So, he threw money at it in the form of a pilot program. It was buried in a budget bill. But unlike the Covid money, these bucks didn’t just buy new RV’s for clinic administrators. These centers saw a 60% growth in patient visits for the five years after the investment.

But more community clinics didn’t solve the national problem. The number of uninsured continued to grow. By 2010 we were up to 16% uninsured.

Then along came the ACA (Obamacare). Rather than saying “NO” to anything Republican, the value was seen. The Community primary care clinics got morphed into FQHCs.

Here’s my FQHC elevator description. I’ve learned to do this because people’s eyes glaze over midsentence when talking about health care funding and delivery. Yours probably did in the first paragraph.

FQHCs must have a community governance board. They must provide a range of health services including primary medical care, dental, behavioral health, substance abuse services, among others. They must provide a sliding fee scale and agree to see all patients regardless of their ability to pay.

In return, the clinic receives enhanced reimbursement for Medicare and Medicaid services.

“Who cares?” you may ask.

Idaho does. Because this model has been advanced into behavioral health care and Idaho is embracing it. Welcome the Certified Community Behavioral Health Clinic. (CCHBC).

CCHBCs are required to provide an array of services. But the CCHBC model requires community governance and agreement to provide service regardless of the patient’s ability to pay, just like the FQHC.

The Idaho Department of Health and Welfare (IDHW) Behavioral Health (BH) Division has announced a couple big moves in the past few months. First, there is a move to establish multiple CCHBCs throughout the state. Full disclosure, the clinic where I work has committed to this.

One of the services required of a CCHBC is 24/7 availability for crisis care. IDHW can thus diminish their staff obligation for crisis teams.

Make no mistake, somebody is going to pay. It’s just who, when and how. And that brings me to the next big announcement from IDHW. A managed care contract has been awarded for both inpatient and outpatient BH. It’s the biggest contract ever awarded in Idaho, $1.2 Billion, with a “B”.

The two companies who weren’t awarded the contract are both suing, so maybe there’s some uncertainty.

It is of note that the company that has had the Idaho BH managed care contract for the last ten years, Optum, bid on the contract and did not win. This is despite their claim they saved the state $400M in Medicaid costs.

I hope the interim legislative committee looking at managed care for Idaho Medicaid is paying attention to this. Behavioral health is small potatoes compared to all of Medicaid. I’ll bet there’s a lot of lawyers who would love to see that contracting lawsuit walk through their office door.

I hope the acronyms haven’t swamped you. It’s an interesting swamp to me. I’m just trying to keep my boots on for now.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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