Because of the short shelf life of an open vial of vaccine, health centers opted for dedicated vaccination clinics instead of individual appointments, to avoid wasting doses, said Andie Martinez Patterson, a senior vice president at the California Primary Care Association, which lobbies for the state’s health centers.
Lack of payment is “untenable given these providers’ financial restraints and tremendous outlay of resources during this historic pandemic response,” Barbara Ferrer, director of the Los Angeles County Department of Public Health, wrote in a Sept. 22 letter to CMS Administrator Chiquita Brooks-LaSure. In interviews, clinics cited high expenses related to vaccination, including running community-based clinics and targeted social media campaigns.
“There’s a tremendous amount of misinformation and disinformation out there,” said Jim Mangia, CEO of the St. John’s Well Child & Family Center in Los Angeles, which opened 26 vaccination sites and operates three mobile units. “You kind of have to do double the work to counter it.”
Angel Greer, CEO of Coastal Family Health Center on Mississippi’s Gulf Coast, said not receiving payment to help cover the clinic’s staffing costs is detrimental. More than 50% of the health center’s patients are uninsured — and 14% each are on Medicare or Medicaid. The federal Health Resources and Services Administration separately reimburses clinics for vaccines administered to uninsured people.
In Mississippi, state officials initially proposed a plan that would have reimbursed health centers at the Medicare rate for stand-alone vaccinations. CMS has not approved it.
“I’m sure, across the nation is no different than Mississippi in our struggles to maintain adequate workforce. It’s extremely difficult to be competitive with these workforce constraints when we’re not being reimbursed for these services,” Greer said. The health center administered 1,000 covid vaccine doses in September, with the “overwhelming majority” occurring outside a regular medical visit, Greer said.
In winter 2020, it became clear California clinics were going to have to eat the costs of vaccination for a while, Martinez Patterson said. They were “hoping on a prayer that most of their costs would be reimbursed” but went ahead and vaccinated patients anyway.
Scott McFarland, CEO of MCHC Health Centers, said his staff at four clinics in rural Lake and Mendocino counties have administered 3,500 shots without reimbursement.
“I’m fairly confident that we will eventually get paid, but this is one of the downsides to being a community health center,” McFarland said, a sentiment others expressed. The clinic is still giving shots, and he thinks the money will come eventually. “It’s just a timing issue, I guess.”
Health centers are pulling from different pots to stay afloat: The American Rescue Plan Act provided $7.6 billion to clinics to support covid vaccination, testing and treatment. Clinics relied on small-business loans from the Paycheck Protection Program, as well as state money, for vaccination efforts. “I do think because of the federal relief, there is not a fire,” Martinez Patterson said.
Health centers in other states echoed that.
“We do not have an issue with reimbursement,” said Dr. Andrea Caracostis, CEO of the Hope Clinic in Houston. She noted that the federal government paid for vaccines and that some health centers’ payment rates cover vaccines.
Fifty-one federally qualified health centers in California earlier this year reported unpaid claims for 1 million doses. The actual total is probably higher; California has 188 health centers.
“We don’t view this small subset, nor the data provided, as sufficiently representative” to accurately estimate the extent of unpaid vaccination claims, Sloan said.
Health centers in California have administered 4.8 million doses, according to federal data.
“We’re just whittling away at it,” said Mangia, of St. John’s.
St. John’s anticipates getting reimbursed for doses under Medicaid in November or December, the clinic said through a spokesperson.
“We know they’re good for it. We know it’s coming,” Louise McCarthy, CEO of the Community Clinic Association of Los Angeles County, said of the Medicaid payments. “But it’s really hard to hire people when you don’t have cash flow.”