Low Medicaid telehealth reimbursement contributing to workforce crisis at FQHCs

A new study published in JAMA Network Open finds that low Medicaid telehealth reimbursement in New York State may be exacerbating a workforce crisis at Federally Qualified Health Centers (FQHCs), particularly among mental health care practitioners. The challenge compounds existing financial instability at FQHCs and barriers to telehealth access among low-income New Yorkers who rely on safety-net care. 

The study, led by researchers at Columbia University Mailman School of Public Health, highlights several possible solutions, including payment parity for telehealth services, long-term funding for telehealth infrastructure, and support for hybrid care models to meet diverse patient needs.

Telehealth has many advantages for patients and providers, but only if it's supported by equitable and sustainable funding policies. Our findings underscore the urgent need for Medicaid reimbursement reforms to address workforce shortages and ensure vulnerable populations can access the care they need."

Thalia Porteny, PhD, first author, assistant professor of Health Policy and Management

The researchers conducted 56 interviews with leadership, clinicians, and administrative staff at six FQHCs in all five boroughs of New York City. Participants described telehealth experiences, including factors related to staff turnover, patient satisfaction, and financial sustainability within FQHCs. 

Key findings:

• FQHCs reported losing up to 40 percent of their mental health staff due to inadequate reimbursement and lack of remote work options, leading to long patient waitlists and reduced access to care.
• Many patients face barriers to telehealth, including lack of internet access and digital literacy, particularly among older adults and those with limited English proficiency.
• Current reimbursement policies create disparities between FQHCs and other providers such as hospitals, leaving FQHCs underfunded and unable to compete for staff or invest in telehealth infrastructure.

"In the face of potential Medicaid cuts and broader austerity measures, our study's findings suggest that it would be detrimental to implement cost-cutting measures in telehealth reimbursements in community health centers in New York and more broadly," says co-author Sorcha A. Brophy, PhD, assistant professor of Health Policy and Management. "Such budget cuts could exacerbate provider shortages, increase barriers to care for vulnerable populations, and ultimately lead to worse health outcomes. Consequently, this could further destabilize community health centers-a healthcare program that has long enjoyed bipartisan support."

An accompanying editorial written by Isaac Dapkins of NYU Langone and NYU Grossman School of Medicine praises the study. Dapkins serves as Chief Medical Officer of a large FQHC in Brooklyn and chair of the clinical committee for the Community Health Center Association of New York. "Porteny et al have presented an outstanding summary of the impact of Medicaid telehealth reimbursement changes. FQHCs have been a core pillar of access to care in the US for years and are a model primary care service delivery," he writes.

The study was co-authored by Emily Burroughs, a former Columbia Mailman research associate.

This study was funded through a Seed Grant Award from the Columbia Population Research Center, awarded to Brophy and Porteny.