Funding scare having long-term impacts at Kaua’i Community Health Center

Wait for dental care at Waimea clinic now 3 months

Legislative efforts late last week restored $112,000 worth of state funding to the Kauai Community Health Center in Waimea. The center’s doctors continue seeing patients, but without a signed contract for the funds, and without hope of receiving state reimbursement for patients seen before the contract is signed.

“We do not yet have a contract, and are not sure when that will arrive on our door,” said David Peters, chief executive officer of Ho’ola Lahui Hawai’i, a nonprofit corporation managing the private, nonprofit Waimea health center.

The Kauai Community Health Center provides medical, dental and behavioral health (including substance abuse) treatment to the uninsured and underinsured, in Waimea now, but with plans to open an Eastside clinic by the end of this year.

Though state Department of Health Director Dr. Chiyome Fukino announced last week the funding had been restored, the money won’t flow until there is a signed contract, and then the center is reimbursed only after seeing patients, Peters said.

The funding is not a lump sum or a grant. The center is reimbursed per visit under the yet unsigned contract. “In other words, if we have 50 uninsured visits in February, then we can bill for 50 visits at $90 per patient, provided we have a signed contract,” he explained.

“Until we have a signed contract, any of the patients we are now seeing, the health center will not get reimbursed for those visits. We cannot capture any revenue on patients already seen before the contract is signed,” he said.

Last week, Gov. Linda Lingle announced that 5 percent of the center’s annual budget would be withheld to help balance the state budget. That $112,000 was being counted on to try to care for more low-income or otherwise disadvantaged Westside residents, and whittle down a three-month waiting list for dental care, Peters said.

Fukino’s announcement Friday was that a mistake had been made by budget analysts, who thought unencumbered funds halfway through the state’s fiscal year meant the funds could be used to balance the state budget.

Later, it was learned that those funds, included in $1.6 million originally slashed from the budgets of all 10 community health centers across the state, wouldn’t help balance the state’s general fund, as the medical funds were taken in a one-time appropriation from the state’s rainy-day fund, Fukino said.

The Kaua’i funds are anticipated to cover over 1,300 patient visits, about half of those dental. “Many of our patients use (a combination of) medical, dental and behavioral health services,” said Peters.

“The wait for the non-emergency dental patient is due to limited staffing and facility limitations (three chairs and two dentists). The mobile clinic goes out weekly to Anahola, and it has only one chair,” Peters said.

Primary care is even more of a challenge, with one doctor who must also function as medical director. “A nurse practitioner (expected to be hired by late spring) will help relieve some of this, but the Eastside expansion is of prime importance for us,” he said.

“A majority of our patients present with complex medical conditions that take a great deal of physician time to manage,” he said.

“We cannot yet determine how many additional providers we will be able to hire to reduce the backlog, and when those providers will be hired. We just hired our second dentist (last month) in anticipation of these funds. We are also looking for two new dental assistants,” Peters said.

Establishment of an Eastside clinic hinges on securing additional federal, state and private funding. “We are working on the staffing plan, so are not sure how many additional providers we will be able to afford in the first year. It all depends on getting the grant funds to succeed,” he added.

In addition to providing medical, dental and behavioral dental care, center staff also offer help in determining whether or not patients can qualify for QUEST and Medicaid medical assistance for low-income folks, and offer limited medications, some donated, and others through patient-assistance programs from pharmaceutical companies, Peters said.

Many of the patients are Native Hawaiians, and overall needs are expected to expand on the island, he pointed out. “As more people have no health insurance, the additional funding is important,” said Peters.

While not getting that latest state funding wouldn’t have meant the center would have to close its doors, it would have hurt, he said.

“We were counting on the funding to help us to meet the overwhelming demand,” said Peters, adding that this is the first (and possibly only) time the center will receive such a reimbursement contract from the state’s rainy-day fund.

The Kauai Community Health Center, near Kauai Veterans Memorial Hospital at the West Kauai Medical Center along Waimea Canyon Drive, is part of a statewide group of community health centers that are private and nonprofit, and provide medical and dental services to uninsured and underinsured patients, and others with barriers to other medical care.

Staff Writer Paul C. Curtis can be reached at pcurtis@pulitzer.net or 245-3681 (ext. 224).

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