In Missouri, there are dozens of federally qualified health centers — government-supported clinics that are required to serve every person who walks in the door.
Most of those clinics are operated by nonprofit organizations. But St. Louis County health officials are banking on a plan that would grant its government-operated health clinics a similar status.
The Department of Public Health this August submitted an application to the U.S. Department of Health and Human Services seeking to designate its health centers in Berkeley, Sunset Hills and Jennings as federally qualified health center lookalikes.
If the federal officials grant the request, it could provide the health department at least $6 million more annually that could be funneled back into treating the patients who rely on the county’s safety-net health system.
“Think about the most vulnerable populations who might not have access to private insurance – [people on] Medicaid, Medicare, those who are uninsured,” said Dr. Kanika Cunningham, the county health director. “Unfortunately, at our hospital systems, the health care costs and expenses will be significant for individuals. So that's where you have a community health center come in, to meet that need.
Many of the county's patients have few options, Cunningham said.
“It may appear that we have a lot of health systems in the St. Louis region, but we break it down by who has access based off of insurance,” she said. “That's where community health centers come into play.”
Providers of last resort
According to a county spokesman, about 40% of the county health department’s $79 million budget — or $32 million this year — goes to clinical services. That includes funding for corrections medicine, pharmaceuticals and the three clinics.
The county offers residents primary care services, immunizations, women’s health, dental care and pediatrics at the centers. According to County Executive Sam Page, the clinics serve approximately 7,000 residents each year.
Health centers operated by county health departments have become rare as governments focus limited funds on infectious disease control and other core functions, said Joe Pierle, CEO of the Missouri Primary Care Association. Most counties don’t have a single clinic, let alone three.
“This would be the first public FQHC that we have in the state if they are in fact approved,” he said.
The county’s clinics already largely fulfill the same mission as federally qualified health centers, Pierle said. They meet many of the government's requirements: offering care on a sliding scale, providing a spectrum of health treatments and treating every person regardless of their insurance status.
“If they're going to continue to operate these clinics, as is, they have a greater opportunity to generate more revenue as an FQHC than they would just continuing the status quo,” he said. “So this will likely allow them, like I said, to generate more revenue and probably offer more services to county residents.”
A need for more resources
St. Louis County’s clinics are particularly busy this time of year.
At the John C Murphy Health Center in Berkeley, county health workers are busy with patients, providing vaccines for people coming back to school and preparing for the upcoming flu season.
On a recent weekday, county resident Laura Romero, who just arrived in the country from Mexico, was waiting for shots with about a dozen other patients. She needed the immunizations as part of her immigration process.
Romero doesn’t have health insurance yet, so she said going to a commercial pharmacy was out of the question.
“One of those shots was $110, and another one was $145,” she said. “And so here I get charged for both vaccines for $20. So I think this is a great place to be.”
People like Romero, who lack insurance and have few affordable options for health care, are those the county-run clinic is designed to reach, said health officials.
But there was also plenty of grumbling in the waiting room. County resident Kristy Clark had just moved to Maryland Heights and had skipped work to get her child vaccinations at the clinic. She said she had been waiting for hours.
“They’re so short-staffed,” she said. “Wouldn’t you think you’d have more than one or two people? Why don’t you have more workers who can give shots?”
Hiring and retaining employees at the health clinics has been a problem. According to county records, the number of quarterly clinic visits decreased 20% between 2021 and 2022, largely because health centers didn’t have enough workers to serve patients.
While the health department's budget has increased, the costs for providing care have gone up significantly, county officials said. The Jennings health center and other buildings need repairs and improvements.
“Public health is significantly underfunded,” Cunningham said. “I think it was very apparent during the pandemic. And now we're trying to recover. The big thing is workforce investment, infrastructure, stability.”
Aiming for better rates
Securing a designation as a federally qualified health center would bring the county more money because many of the people it serves depend on government assistance, said Derek Melton, CEO of FQHCs for the health department.
“The perception [of] residents that live in the county is that they are exceptionally well-off from a financial standpoint,” he said “[But] over 80 and 90% of our patients that we see there are county residents are under some type of government-assisted insurance payment model. … That’s Medicaid, Medicare.”
The treatments the county provides to Medicaid and Medicare patients are reimbursed by the federal government at a much lower rate than reimbursements paid by United, Anthem or other private insurance carriers. Some patients have no insurance at all, and the health department budget fills the gap.
If federal officials approve the county's request, Medicaid and Medicare will reimburse the county more money for the care it provides. The department will obtain medicine at lower prices and could be eligible for certain federal grants down the line.
“These are all taxes that people in our community pay to the federal government, and as much of that we can bring back to St. Louis County to provide services, we should,” County Executive Page said. “There are resources available from the federal government to help pay for those services. And if those services are paid for, we could provide more services.”
‘Gearing up’
Melton, of the health department, said if federal officials accept the county’s application, they’ll come to the county’s clinic for a site visit.
The health department is ready. To prepare, it’s been running dress rehearsals.
“We're really gearing up to when they come in and look at us from an on-site visit that we're already postured, and we're doing the type of work that we're doing,” Melton said.
