How one rural health center has adjusted to patient uptick since Medicaid expansion

The expansion of Medicaid under federal health care reform put many rural health clinics, especially in areas that were already experiencing doctor shortages, in tight spots. Kaiser Health News examines how the Redding-based Shasta Community Health Center in Northern California accommodated the influx of patients after health care reform. (Best Places map: Redding, Calif.)

In 2014 the number of people insured under Medi-Cal, California’s version of Medicaid, increased to 40,000 in the region served by Shasta Community Health, Pauline Bartolone reports for Kaiser. CEO C. Dean Germano said they were not prepared for the deluge of new patients, and he "decided to close the network’s five clinics to new adult Medi-Cal patients, though they continued to serve all of their existing patients and accepted new children." This month they began accepting some new patients.

Germano told Bartolone, "We quickly became overwhelmed, although there were a couple of things happening all at once. One was certainly the growth in Medicaid coverage, but at the very same time, the state of California expanded Medi-Cal managed care into 28 rural counties. We are one of them. We did not have Medi-Cal managed care prior to this."

"We were assigned patients, then assigned more patients," he said. "We quickly reached a point where we could not take on more new adult patients to our practice. We had to essentially constrain and at one point close the practice to new adult Medicaid patients." While the practice still accepted the uninsured and homeless, Germano said, "It was a very big hit [to] the community because adult patients had to go further afield to find services outside of the emergency room. Under managed care, it’s [the health plan’s] responsibility to find a medical home and some of the medical homes were 30 to 40 miles into the mountains. For patients who have transportation issues, there was no doubt that was a real imposition."

Since 2014, Shasta Community Health Center "has hired two physicians, created a family practice residency program and has a fellowship program for nurse practitioners and physician assistants," Bartolone writes. "For every new primary care provider, the clinic network can add up to 1,200 new patients, Germano said. The system now serves about 60,000 people in the area."