Program that provides health care to thousands in N.O. on verge of going broke _lowres

Advocate staff photo by DANIEL ERATH -- Daughters of Charity Gala. Cleland Powell, Sister Bonnie Hoffman, Michael Griffin.

A program that provides health care to tens of thousands of uninsured New Orleans-area residents — and helps fund clinics that care for an even larger population — will run out of money in August, and officials say there’s no clear plan for keeping the program running.

The Greater New Orleans Community Health Connection provides health services to about 53,000 enrollees through dozens of clinics in the region.

Though widely praised by both state and local officials, the program is in danger of closing as officials scramble to find the $9 million necessary to keep it running for another year.

“I think we have lots of support for the program. I think everyone wants to continue the program and recognizes the value of the program,” state Sen. David Heitmeier, D-Algiers, said. “It’s just hard finding the dollars right now.”

GNOCHC covers residents who fall below the poverty line but whose income is too high for the relatively stringent requirements to enroll in the state’s Medicaid program. GNOCHC makes them eligible for primary care services and preventive health services that otherwise would not be available.

“That is key, a critical element to changing the health status of our population, and all of that is about to sunset and go away,” Daughters of Charity President and CEO Michael Griffin said.

Proponents say the Community Health Connection program is good not just for patients but also for lowering the cost of health care in the area. Providing preventive health services and programs to manage chronic conditions such as diabetes can keep patients from turning to emergency rooms — which have the highest-cost care — and can prevent illnesses from becoming more serious.

504Healthnet, an organization that works with clinics in the New Orleans area, estimates that the nearly 97,000 yearly visits paid for by GNOCHC save roughly $59 million a year in medical costs.

“It’s an extremely important program for the New Orleans community,” said LCMC Health President and CEO Gregg Feirn, whose company runs the Interim LSU Hospital and its clinics, which participate in GNOCHC. “It has helped create a vast network of primary care clinics unlike any other network across the country, and it is providing those preventive care services to individuals who otherwise wouldn’t have access. Ultimately, that preventive care does reduce the cost of health care.”

For Daughters of Charity, which runs clinics throughout the New Orleans area, the end of GNOCHC would mean the organization would have to consider making cuts to its clinics, Griffin said.

“It would be very hard to continue the present level of service. We’d have to make some hard decisions about the level of service we continue to provide,” Griffin said.

That would include taking a look at the organization’s newly opened center in New Orleans East, where about 40 percent of the patients are covered by GNOCHC.

Overall, providers say they’d have to cut about 24 positions in the region should the program not get funding, 504Healthnet Executive Director Susan Todd said.

The GNOCHC program has its roots in a post-Hurricane Katrina federal grant to provide primary care services to the uninsured in the New Orleans area. In 2010, that program was replaced with GNOCHC, which is funded by federal Medicaid money.

With that change came new restrictions on eligibility and a requirement that local governments bear some of the costs. Every dollar Louisiana agencies put into the program draws down additional federal money, as with the rest of Louisiana’s Medicaid spending.

Since the start of the program, the state has paid for it using Community Development Block Grant funding. But with lawmakers and Gov. Bobby Jindal’s administration already wrestling with a gap in next year’s budget, further state funding appears to be off the table.

The population covered by GNOCHC falls within the income limits of the Medicaid expansion that is part of the Affordable Care Act, or Obamacare. But that expansion, which would be fully paid for by the federal government in its early years, has been opposed by the Jindal administration, and an effort to get around the governor’s opposition was shot down in a state Senate committee last week.

Asked about the funding shortfall, a spokesperson with the state Department of Health and Hospitals said the agency would assist with preparing the paperwork for an extension of the GNOCHC program but that money for continuing the program would have to come from the local level.

Officials in New Orleans Mayor Mitch Landrieu’s office did not respond to requests for comment on GNOCHC’s funding situation.

Roughly 8,000 of the 28,000 people who use Daughters of Charity are enrolled in GNOCHC, and the Daughters’ clinics receive $205 from the program for each visit by one of those patients, Griffin said. That’s compared to the $25 those patients otherwise would be forced to pay out of their own pocket for an appointment — a real concern for those struggling to make ends meet.

“Those are real choices for the people who have to make those decisions every day,” Griffin said.

The impact of GNOCHC goes beyond those who are directly enrolled in the program, health officials said. The clinics all cater to a mix of patients, including those enrolled in GNOCHC, those in traditional Medicaid programs, the uninsured and patients with private insurance.

That mix means it’s unlikely the end of GNOCHC would mean the end of all those clinics in New Orleans. But it would drive patients to methods of care that are more expensive for the taxpayer.

“Nothing directly will happen to those clinics other than their primary care volume may drop, and ultimately that volume may show up in the emergency room,” Feirn said.

At Daughters of Charity, the additional money the clinics get from GNOCHC helps pay for professionals, such as social workers, who work with patients on managing their illnesses and health, Griffin said. Those services would disappear without that money, further driving up costs and leading to a less comprehensive approach to healt care, he said. And those cuts would affect not just those using GNOCHC but all patients — whether insured, uninsured or covered by a government program — who use the organization’s clinics, he said.

Officials have been looking into a variety of options to continue the program, including finding private donors or new sources of state or local revenue, but so far none has come to fruition.

“We’re still looking under every rock,” Heitmeier said.