Access grants face uncertain future in Congress

The Community Access Program helps areas better coordinate charity medical care for low-income, uninsured patients.

By Amy Snow Landa, amednews staff. Nov. 26, 2001.

Washington -- As Congress rushes to complete its massive spending bills this year, a small grant program that helps communities improve their health care safety net faces uncertain prospects.

For the past two years, the Community Access Program has awarded grants to local communities to help them better integrate health care services for low-income, uninsured residents, who often fall through the cracks in the health care system.

Funding's ebb and flow

Established as a $25 million demonstration project in fiscal year 2000, CAP saw its funding grow to $125 million the following year. So far, it has awarded grants to more than 130 communities in urban and rural areas and on tribal lands.

The program has been widely praised -- both in Congress and among safety net providers -- for enabling communities to build links between health centers, public hospitals, volunteer physicians, health departments, and other public and private organizations.

Many communities have used their grants, for example, to build organized referral networks that link community health centers, which provide primary care services, to volunteer specialty physicians.

But earlier this year, the Bush administration proposed eliminating CAP. Health and Human Services Secretary Tommy Thompson explained in a letter to Congress that the administration's priority is to support the "direct provision" of services, not their integration or coordination.

Early Senate support for the program seems to have trickled away.

But CAP supporters say that by better coordinating the uncompensated care that is provided, they are able to increase its effectiveness and have a larger impact.

"In Omaha, Neb., I think they're getting more than their money's worth," says Michelle Knolla, MD, president of the Metro Omaha Medical Society.

The Hope Medical Outreach Coalition, a local nonprofit coalition that treats more than the 4,000 uninsured patients in the Omaha metropolitan area each year, was awarded a $1 million CAP grant in September, which is when the program disbursed the last of its remaining funds to 60 organizations. The coalition's plans for using the grant include offering pharmacy services, interpreters and transportation to patients, and training local health system personnel in screening and referrals.

Omaha's medical society has helped recruit and coordinate volunteer physicians who treat patients free of charge at their offices and at community clinics. It is a role that makes sense, Dr. Knolla said, because the medical society knows how to link doctors with the public health needs of the community.

"We've been working at this for a long time, and I think we've got it down pretty well," Dr. Knolla said. "We just need money to expand the services."

The Omaha coalition and other communities that have received CAP grants could apply for a supplemental grant if the program continues operating.

The National Assn. of Public Hospitals & Health Systems and the National Assn. of Community Health Centers have both been lobbying hard for the program's continuation.

Congressional negotiations ongoing

But whether CAP continues to receive funding next year is in the hands of a House-Senate conference committee charged with hammering out a spending bill for the Depts. of Labor, Health and Human Services, and Education.

The House and Senate already have approved separate spending measures that vary widely on this line item.

The House-passed measure would provide $105 million, a drop of $20 million from the present level. But the Senate version provides only $15 million that could be used for CAP but could also be used entirely for another grant program.

Ironically, support for CAP had seemed particularly strong in the Senate earlier in the year, with Sens. Bill Frist, MD, (R, Tenn.) and Edward Kennedy (D, Mass.) among the program's staunch advocates. In addition, the Senate Health, Education, Labor and Pensions Committee approved legislation in August that would convert CAP from a demonstration project to a permanently established program, renamed the Healthy Communities Access Program, and authorize it at $125 million.

Since then, the momentum seems to have trickled away, according to one observer. "What seemed certain three months ago is now totally up in the air."

There is concern that CAP may get overlooked among the many competing priorities in the Labor-HHS-Education appropriations bill -- usually one of the most difficult spending bills for Congress and the White House to resolve. For now, the program has stopped taking new applications until it is clear that there will be funds to award.

ADDITIONAL INFORMATION:

Funding's ebb and flow

The evolution of the federal Community Access Program grants:

Fiscal 2000 Congress establishes CAP as a demonstration project and provides $25 million. Grants are awarded to 23 communities.
Fiscal 2001 Congress increases funding to $125 million. New grants are awarded to 133 communities and supplemental grants to the original 23.
Fiscal 2002 The Bush administration proposes eliminating CAP, but Congress has not yet decided whether to continue its funding.