At community health centers across Oklahoma, new patients typically have to wait more than two months for a dentist appointment. Those waits may get even longer.
And throughout swaths of rural Oklahoma, nonprofits that provide child-abuse prevention services for hundreds of families have halted their programs. Others are looking for alternative funding sources to stay afloat.
News about the financial crisis at the Oklahoma State Department of Health has focused lately on accounting schemes and questions of oversight. Getting less attention is what the debacle could mean for public health.
The health department announced last week that county health department operations will change as “unique and innovative ways” to provide health care are pursued
Interim Health Commissioner Preston Doerflinger said in a news release, “Public health delivery is not solely the responsibility of our state infrastructure, but through important collaborations and private partnerships we can continue to create a state of health.”
The language and job cuts announced in October suggest a leaner state health department will become the norm. The Legislature approved $30 million in emergency funds to fill an agency shortfall caused by financial mismanagement. But 200 job cuts are still planned by March. Doerflinger said earlier that former department leaders diverted federal funds to pay for “costly programs beyond the agency’s core public health initiatives.” But he did not name those programs.
Some programs have already been cut and could be harbingers of a less robust public-health system.
In October, the department said it would cancel contracts with 25 federally qualified health centers and nine child-abuse prevention programs. Oklahoma Watch recently checked with some of those programs to see what the impact has been.
Preventing Child Abuse
Parent Promise in Oklahoma City is among the nine contractors whose five-year agreements to provide child-abuse prevention services were canceled. The providers were to receive a total of $2 million annually, and their five-year contracts had begun in in August.
A key component of these organizations’ work is home visits to families whose children are at risk of abuse. They offer guidance in areas such as stress management and child care. Parent Promise has done more than 1,900 home visits to 154 families this year.
The nonprofit was able to make up for the loss of its $276,202 abuse prevention contract using savings and donations but is looking for long-term solutions.
Executive Director Sherry Fair said state law specifically calls for providing child-abuse prevention services, making it a “core service.” It’s a point that’s likely to come up next year, when the organization plans to ask legislators to restore funding.
Other nonprofits that offer child-abuse prevention haven’t fared as well.
At Tahlequah-based Health in Crisis, four parent educators worked with 150 families, visiting homes of at-risk families in a four-county region in eastern Oklahoma. They no longer have jobs, although there’s hope for reviving the 27-year-old program through a partnership with a local mental health agency, said Laura Kuester, executive director of Health in Crisis.
The loss of the contract was a blow.
“When I go to bed at night and think about how we can help … for me every single time it comes back to prevention,” Kuester said. “We need to be in homes. We need to be working with these parents who are asking for some help.”
Participation in the child-abuse prevention program is voluntary. Families contact the agency directly or get a referral from another source, such as a clinic or medical provider. Health in Crisis developed the program beyond the contract’s requirements, providing families with diapers, baby formula and Thanksgiving baskets.
In Ponca City, Northern Oklahoma Youth Services, offered the program with three workers but but has ended it entirely.
“There’s a big hole left by the loss of the program,” said Executive Director James Carter.
Carter said the short notice on the cancellation – 30 days in the middle of a fiscal year – didn’t leave enough time to make other arrangements for funding.
“The timing was horrible to be able to do anything,” he said.
A similar scenario unfolded in Northwest Family Services in Alva, where the nearest hospital for expectant mothers to deliver babies is at about 65 miles away.
Brenda Rose, the agency’s interim director, at one time supervised the program, working with another educator to help 55 families in a four-county region.
“I am fearful there are going to be more and more child welfare referrals because of not having those parent educators in homes,” Rose said.
Besides educating parents, Rose and the other worker took mothers to doctor appointments and provided diapers, formula and car seats. They also screened children for developmental disabilities in order to get youngsters into early intervention programs.
At The Parent Child Center in Tulsa, six parent educators, a manager and an administrative assistant work with about 200 families.
The $443,988 contract paid for the agency’s entire staff. The center has enough money now to keep going until mid-February, and is scrambling to find other funding sources, said Carrie Little, director of external relations. Employees are preparing for the worst, she said.
Other groups face similar circumstances.
“If we’re unable to find funding from someplace else, we’ll have a layoff,” said Sarah Neyman, program manager at the Tulsa center. “At this point, we haven’t received any funding to be able to continue. All of my workers are updating resumes and preparing themselves.”
But Neyman said her biggest concern lies with the clients they would leave behind in less than two months.
“Once this goes away there aren’t any other services, and I think that’s the most devastating part,” Neyman said.
Community Health Centers
Federally qualified community health centers accept patients with traditional insurance but also treat the uninsured, who pay a steeply discounted rate based on a sliding fee scale based on income. In general, the centers help adults who earn too much to qualify to Medicaid but can’t afford insurance.
Brent Wilburn, director of public policy for the Oklahoma Primary Care Association, said community health centers include some 20 organizations serving more than 200,0000 Oklahomans. State funding is key and covers uncompensated care when other avenues, such as Medicaid and Medicare, aren’t an option.
Statewide, the centers had a $1.9 million annual contract for uncompensated care that was canceled. The contract was supposed to last through June 30, 2018.
Each month, health centers reported costs for services to the uninsured, and were paid out of a state funding pool. Even then, available dollars typically covered less than 30 percent of the costs.
“Then they just turned the spigot off,” Wilburn said. “That’s pretty disruptive when it’s your last dollar for those services.”
The uncertainty is compounded because the centers are still waiting for Congress to reauthorize the Children’s Health Insurance Program, which also is critical to their funding. Congress recently extended CHIP funding, but only through March.
Options include seeking donations and reducing services by trimming hours or keeping positions open.
At the multi-site Health & Wellness Center in rural eastern Oklahoma, about 25,000 patients in a six-county region receive medical care and other services, including dental, optometry and behavioral health.
“We are in a hiring freeze at this point and we’re considering what to do moving forward with services and hours,” said Chief Executive Officer Teresa Huggins.
“It’s really difficult to plan moving forward,” she said. “Then you throw in the federal budget and the uncertainty and delay.”
Lou Carmichael is the chief executive officer of Variety Care, a group of community clinics in the Oklahoma City area and southwest Oklahoma. The group of has about 90 licensed providers, including dentists, doctors, nurses and pharmacists.
The organization serves about 57,000 patients. Roughly one-third of Variety Care’s patients are uninsured, similar to other federally qualified health centers in the state.
Federal funding that’s available can only go so far. If Variety Care spent all of its federal funds on serving the uninsured, it would only serve about 7,500 people. In 2016, the center had 17,500 uninsured patients.
The funding loss could mean losing sites, Carmichael said.
“We’re sort of watching it to see if we can get some kind of a restoration for that in 2018,” she said.
In the meantime, Variety Care is keeping costs in check through attrition and longer wait times for appointments.
“What really happens in the community is that door is closed, which is an affordable, accessible door, so the only door available is the emergency room, which burdens our ERs,” she said. As a result, people put off treatment for minor problems until they get worse and become more expensive. “This is a very bad strategy,” she said.
Carmichael noted that one of the organization’s dentist positions is vacant. There are 10 other dentists for multiple sites, but one vacant position represents thousands of more appointments and people a year who could get access.
That wait could grow to four or five months with fewer dentists.
“That’s a long time to wait for a toothache,” she said.
Reach reporter Ben Botkin at firstname.lastname@example.org or (702) 418-6089.