By Krista Yacovone
Intern, Disaster Accountability Project

(Krista is a rising 2L at Fordham University School of Law in New York City)

On June 30, 2010, the Government Accountability Office (GAO) released a report describing what steps the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), both part of the Department of Health and Human Services (HHS), have taken to sustain the primary care gains made in the greater New Orleans area by the organizations funded by the Primary Care Access and Stabilization Grant (PCASG). Underscoring the report’s positive findings of future sustainability was the concern that after the PCASG funding ends on September 30, 2010, the positive growth since the grant’s inception on July 23, 2007, will unravel.

The PCASG is a 100 million dollar grant given by HHS to the Louisiana Department of Health and Hospitals (LDHH).  It was designed to meet the increasing demand for health-care services in the greater New Orleans area, which includes Jefferson, Orleans, Plaquemines, and St. Bernard parishes, in the wake of Hurricane Katrina and the loss of Charity Hospital, which cared largely for New Orleans’ uninsured population (at 22%, the region has one of the highest rates of uninsured adults in the country).

The PCASG was also intended to provide high quality primary and behavioral health care at the community level, and to decrease reliance on emergency rooms for conditions more appropriately treated in an outpatient setting. Along with the Louisiana Public Health Institute (LPHI), LDHH administers PCASG funds to the twenty-five eligible organizations. For an organization to be eligible, it must have been a public or private nonprofit organization serving patients in the greater New Orleans area at the time of the grant proposal’s submission in June 2007. It must also have shown the intent to be sustainable after PCASG funding ends.

This sustainability, however, was questioned in the GAO report. Although the GAO found that CMS and HRSA have offered five types of assistance to the PCASG-funded organizations – funding, training, information sharing, technical assistance, and workforce support – the long-term viability of the provider organizations remains a concern. For example, the GAO noted that some provider organizations may not be eligible for, or interested in, pursuing extended grant funding options provided by HRSA via the American Recovery and Reinvestment Act and the agency’s regular Health Center Program grants.

Additionally, the large number of uninsured patients served by PCASG providers creates a sustainability issue itself. While providers are now able to bill more patients than they were three years ago, there is an anticipated three-year gap between the end of PCASG funding and the start of increased coverage. The concern remains that in the interim, the providers will be unable to continue service without outside funding.

These concerns are especially pertinent in the face of the Gulf oil spill. Over the past three years, about 100,000 people have relied on PCASG-funded organizations to provide not only primary care but mental health counseling and substance abuse treatment in the greater New Orleans area. As studies continue to be released on the mental and physical health threats facing Gulf coast residents (as the DAP blog reported earlier in the summer), and as substance abuse threatens to rise in the wake of the oil spill’s devastating effects, the importance of the region’s federally funded health clinics cannot be overstated.

While the GAO did not issue any recommendations as to how sustainability should be bolstered, a recent report from the Brookings Institute on the state of New Orleans five years after Katrina addressed the region’s health care needs. The Brookings report noted that because of federal funding, coupled with community-based, grassroots efforts, the region’s health care system has markedly improved from the weak, ineffective system in place before Katrina. Since PCASG, costly emergency room visits have declined as patients began to rely on the neighborhood centers, instead. The Brookings report cautioned, however, that to maintain the progress in the region, sustained gap funding should be provided to the community-based health centers to ensure ongoing care of the uninsured.

In a region plagued by disaster, this recommendation highlights the importance of the quality gains made in the past five years. In the coming months, Gulf coast residents will require continued oil spill-related care, both physical and mental. An end to the community-based health care system will lead, once again, to the flooding of emergency rooms for primary care. It will threaten to eliminate the new substance abuse and counseling centers, a service that is sure to become crucial to Gulf coast residents in the coming months.

One important step taken only days ago was BP’s award of $52 million to fund behavioral health support and outreach programs along the Gulf coast. This comes in part as a response to LDHH Secretary Alan Levine’s repeated requests for BP’s funding of mental health services in the region. The award will be given to federal and state health organizations and distributed among affected states.

Hopefully, the money granted to LDHH ($15 million of the $52 million) will be used to bolster the PCASG-funded organizations and provide a cushion when the federal funds stop. However, it is unclear whether the BP funds have been earmarked for this purpose. While they are slated to support mental health services by buttressing outreach, family, and individual counseling, as well as clinical visits and medication, this reinforces only one prong of the PCASG organizations’ role. These organizations must be given the full funding and support required to sustain their development, growth, and positive role in helping New Orleans rise from the ashes.