Safety net health clinics brace for potential funding cuts

At Face to Face Health and Counseling Service in east St. Paul, mental health therapist Dorothee Tshiela's responsibilities stretch well beyond what her training prepared her for.

"I'm case-managing and helping people get their Social Security cards," she said. "But we don't have the funds to do that, so a lot of us that work there just say it needs to happen, and we can help them do that, but we eat a lot of the cost."

The community clinic opened in the early 1970s and provides medical and mental health services to patients ages 11 to 24.

"In that age range, there can be underinsured clients and people who I think end up falling through the cracks because they're not getting enough support at home or things aren't going well at school or in the neighborhood they live in," Tshiela said.

Face to Face is one of dozens of community clinics across the state bracing for the possibility of drastic cuts in state funding at the end of the year. Community health clinics serve people who are uninsured or can't afford health services.

Lawmakers enacted the Community Clinic Grant Program starting in 2002 to provide a safety net for people who need it. This year, the funding hinges on the fate of a long-standing medical provider tax in the Legislature.

The state offers several types of grants for safety net clinics.

The Community Clinic Grant Program is uniquely useful because clinics can spend the money as they see fit, said Will Wilson of the Office of Rural Health and Primary Care at the Minnesota Department of Health.

"They can use it for operations, or for staff or to purchase equipment," said Wilson.

He said the funds often provide crucial support.

"For example a clinic in Park Rapids, they were asking to replace some aging and broken dental equipment. There's a rural health clinic up in Baudette renovating their exam rooms for [Americans with Disabilities Act] compliance," he said. "In Red Wing, there's a clinic that serves a large Latino population so they asked for funding to hire a bilingual wellness coordinator."

The original legislation for the program provided $3 million. But then lawmakers cut the funding every year until 2009. For the next decade, the amount stayed at $561,000. That's less than one-fifth of the original allocation.

Wilson said the program is only able to help about 10 community clinics each year — out of more than 50 that typically apply.

Gov. Tim Walz isn't seeking more funding for the program. He said he wants to increase access to health insurance as a way to ensure community clinics have sustainable funding.

But Walz also wants to protect a key source of revenue for the grant program.

The state's 2 percent health care provider tax — which generates hundreds of millions of dollars per year — is set to stop at the end of 2019. The tax funds about half of the Community Clinic Grant Program, Wilson said.

"That 2 percent provider tax will disappear and all the funding and programs it supports will either go away or need to find an alternative funding source," he said.

Lawmakers sunsetted the tax in 2011. It dates back to 1992 and funds MinnesotaCare, the subsidized insurance program for low- and moderate-income people.

Walz and other DFLers want to preserve the provider tax. Republicans, who control the state Senate, argue the tax should end as planned, and the DFL's proposed reversal would increase health care costs.

While that debate continues at the Capitol, a few miles away Tshiela said additional funding would help boost wages and prevent the loss of staff looking for what she calls a livable wage. She said that turnover undermines the clinic's mission.

"We don't help as much as we could," she said.

Corrections (March 6, 2019): An earlier version of this story misspelled Dorothee Tshiela's name.