Governor Baker,
Community health centers are in current financial peril and require immediate and substantial financial relief in order to avoid a partial or complete collapse of the state’s largest primary care network and, most urgently, a vitally important part of the Commonwealth’s response to this public health crisis. On many occasions you have recognized the critical role that the community health center network plays in providing care to MassHealth members and the uninsured, as well as the linguistically, ethnically and racially diverse populations throughout our state. However, the COVID-19 pandemic presents an imminent threat to the survival of that network.

There is now a countdown to the closure of community health centers in Massachusetts, all of whom are operating with a diminished workforce, some with under two weeks cash on hand, and many with negative operating margins, and little to no personal protective equipment—as over one million patients continue to rely on them for life saving care, and as the Commonwealth and their communities expect them to be ready and available to test and care for patients with COVID-19. Today, our situation is dire. Soon, when there is a surge, we are deeply concerned that we may not be here to relieve pressure on emergency rooms, nor here to help save lives.

Massachusetts community health centers have transitioned their organizations to rapidly respond to the need for screening and testing of COVID-19 patients, while also continuing to address the urgent non-COVID-19 related medical needs of the vulnerable communities they serve. Based on public health directives to mitigate the spread of COVD-19, health center leaders are making excruciating decisions in real time. Most heath centers have curtailed non-urgent services and sites; suspended dental, vision and routine medical visits—which includes vaccinations. These decisions all have public health and financial implications and consequences, as health center expenses are increasing in response to COVID-19, while revenue drops precipitously. Therefore, immediate and significant financial relief is the only solution for ensuring the short- and long-term viability of Massachusetts community health centers. With this situation changing hour by hour, it is almost impossible to calculate the need, but the order of magnitude is significant.

Presently and for the foreseeable future, the state’s health centers estimate declines of between 50 and 70 percent in their net patient service revenue. Capital Link, a national non-profit that assists health centers with capital and finance needs, says that over the next 12 weeks alone, those declines will result in income losses of between $109 million and $152 million statewide.

The driving factors behind this sudden financial decline are interrelated and can be broken down into three overarching categories: workforce challenges; lack of resources to treat and test patients and protect staff; and spiraling and varied revenue losses.

Workforce Challenges
As the pandemic evolves, challenges already impacting our workforce include: quarantined staff who may have been exposed to COVID-19 and are awaiting test results and clearance; school closures that result in employees staying home from work to care for children; and “high risk” personnel who, because of age or underlying health conditions, must remove themselves from the clinical setting. In addition, health centers that are self-insured for unemployment will face significant financial exposure if layoffs become necessary.

Lack of Resources to Treat and Test Patients and Protect Staff
Personal Protective Equipment ( plays a significant role in ensuring the ongoing safety and ability
of health center staff to address this crisis. Health centers have identified the need for face masks,
specialized N95 respirator masks, gloves and sanitizing wipes and gels with some centers stating
that their supplies will be exhausted at current levels of use within 1 to 2 weeks. Once these supplies
are depleted, health centers will be forced to either close their doors to coronavirus patients or,
alternatively, continue providing services with recycled supplies or without the necessary protective
equipment resulting in increased exposure for front-line medical staff.

Unfortunately, their existing channels for purchasing critical supplies ha s tightened, as group
purchasing organizations ( have begun to ration supplies, limiting health centers to their pre-
pandemic purchasing levels or less This has prompted health centers to aggressively pursue other
sources including online suppliers leaving them susceptible to scams.

Access to testing kits along with medical tents to triage, isolate, test, and treat have also been identified
as critical in the work of health centers to protect the health and safety of their patients and workforce.
This will become increasingly more critical as we anticipate a surge in COVID 19 related cases. The
lack of these resources contributed to early decisions by health centers to suspend or reduce services in
business lines such as preventative dentistry and optometry, reducing patient access and depressing
revenues and diminishing our overall public health response to this crisis.

Spiraling Revenue Losses
Suspensions of entire service lines and canceled visits due to public health imperatives to keep healthy patients out of the health care setting, in combination with workforce and supply shortages, are serving to significantly depress health center revenue. One individual health center has already identified a revenue loss of $2.5 million a month. This level of financial loss is unsustainable, and would cause a ripple effect through the healthcare continuum if health centers are forced to shut their doors.

Healthcenters are grateful to the state’s Executive Office of Health and Human Services, Office of
Medicaid, and the Division of Insurance for the ability to be reimbursed for care delivered via
telephone or telehealth technology during this crisis. This includes screening for COVID 19 and
providing other c are to our patients. Standing up these services in this crisis period will be a challenge
but these changes are vital However this will only replace a portion of the large volume of visits that
will be lost. Notably, this week MassHealth began worki ng with the League on options to help provide
some financial relief in the short term for those with th e most acute financial strain. We appreciate the
work of the Acting Medicaid Director Amanda Cassel Kraft who has been working closely with us to
explore flexible solutions

We also want to thank you for securing U.S. Small Business Administration ( low interest
federal disaster loans for working capital for Massachusetts small businesses suffering substantial
economic injury due to COVID 19 and most especially for including private non profit
organizations Access to these Economic Injury Disaster Loans may help some community health
centers meet their financial obligations and operating expenses.  We also appreciate your securing an
additional $1.08 billion for Medicaid in the most recent relief package that cleared Congress on
Wednesday, aimed at addressing the anticipated increase in enrollment in MassHealth.

Given the scope and breadth of these challenges, combined with the knowledge that they will be
compounded as response to this pandemic in creases, we ask that your Administration work with the
Legislature to take all necessary steps within your power to address them. The League would
encourage immediate cash infusions to community health centers to keep them financially viable
throughout this crisis and beyond whether that be direct allocations through small no interest
loans or immediate access to moral obligation bond financing The Commonwealth has been wise to
invest in a rainy day fund to protect the state in cases of economic downturns or other unforeseen
circumstances, and we hope t hat any decision to tap these funds or FMAP resources will prioritize
community health centers and other members of the safety net

As more data becomes available on financial stressors, we are happy to share them wi th your office
and others to ensure a responsible but effective monetary infusion. Additionally, any ability to mitigate
the increasingly high demand for PPE, whether through the tapping of existing reserves or funding to
purchase more, would be imperative at this point. We are asking that health centers receive priority
consideration for any future distributions.

We know you are giving serious consideration to a myriad of proposals to keep our health care system
strong and robust i n responding to this epidemic. We are grateful for your understanding that
community health centers are the frontlines of defense in an epidemic of this nature, especially for our
vulnerable and underserved communities. We look forward to working with you continuously as this
situation develops and are happy to keep open lines of communication as you deem necessary.

James W. Hunt  .Jr.
President
President && CEOCEO
Massachusetts
Massachusetts LeagueLeague ofof CommunityCommunity HealthHealth CentersCenters