Lane County says it will cut 23 positions at its ‘safety net’ primary care clinics

At the Community Health Centers of Lane County, leaders plan to eliminate 23 positions — 15 now filled by employees and eight that are vacant.

The county’s Health and Human Services department is projecting a $2 million deficit this fiscal year amid federal and state healthcare changes both federally and locally. Without action, the projected deficit for next year is growing to about $6.5 million. 

Eve Gray, director of Health and Human Services, warned county commissioners in September about impending cuts, which were timed to coincide with the consolidation of the health center’s eight clinics into six locations.

The cuts could result in layoffs, according to an announcement Wednesday, June 24. However, affected employees may be reassigned to other county positions if openings are available, Gray said.

The process of notifying workers is still underway, according to Gray. Because of that, she declined to disclose the affected positions publicly to Lookout Eugene-Springfield.

Gray said no existing provider positions are being eliminated. Two of the eight vacant positions were provider roles: one became vacant after a retirement and the other after a resignation. Neither provider had assigned patients, she said.

“Even the staff who at this moment receive layoff notices, those would not be effective until July (for first round) and others the end of September,” Gray said. “There are lots of options for our staff and we take seriously taking care of our people, even as we are managing our budget.”

But the union president for AFSCME Local 2831, Jenn Tipton, who is also a senior stores clerk in Health and Human Services, called the county’s approach “disappointing.”

“Notably the delay in engaging the workers who do this work. It is unfortunate they did not proceed in a more transparent and inclusive manner as solutions remain that protect the services Lane County residents rely on,” said Tipton in an email. “The Department of Health and Human Services remains quite top-heavy with a lot of upper management overseeing fewer and fewer staff providing services.” 

The 15 filled positions slated for elimination represent a 6% reduction of the clinic’s 250-person workforce. The team serves about 30,000 patients through the Community Health Centers of Lane County.

As a federally qualified health center, the Community Health Centers of Lane County is required to provide care to anyone who walks through the doors, regardless of their ability to pay or insurance coverage.

“[We] recognize that our role in the community is primarily as a safety net, and yet right now there is so much need and demand for primary care that we’re identifying where are the places that we need to step in for patients who are, for example, commercially insured and be able to provide what shouldn’t have to be a safety net, but it really is at this point,” Gray said. “Or individuals who are who found themselves in a situation with the marketplace and the changes to the marketplace.”

Last year, tax credits that allow people to get insurance at a lower rate through the Affordable Care Act expired. That has hiked up premiums, for some four-fold, as a Eugene couple testified to the U.S. Senate.

The result for patients at the clinic has been selecting plans with higher deductibles in an effort to reduce their monthly premiums. That means people come to the clinic with deductibles in the thousands, and they are unable to pay their bill when invoiced, Gray said.

Another challenge was Oregon Health Authority’s transition of nearly 96,000 Lane County Medicaid members to Trillium Community Health Plan. Some patients opted for the fee-for-service option, or open card, instead of enrolling with Trillium, reducing the number of patients assigned to the clinic, and in turn, reducing the monthly payments it receives through the coordinated care system. 

In a written statement, Trillum spokesperson Courtney Johnston said:

“The lower enrollment following the transition is largely due to how enrollment works for American Indian and Alaska Native members under the Oregon Health Plan. Federal and state policy requires that American Indian and Alaska Native members choose whether to enroll in a Coordinated Care Organization or remain in the Open Card fee-for-service program, rather than being auto-assigned. As a result, individuals in this group must take an active step to join Trillium. We respect and support Tribal member choice in how care is accessed.”

Although Trillium increased its reimbursement rate to help offset the loss of PacificSource, clinic revenue still fell short, Gray said.

These challenges have led to difficult conversations in a region already grappling with strains on its healthcare system, including provider turnover at other clinics and long waits for emergency care.

And those conversations may be just beginning. Gray said she anticipates Oregon could lose as much as $3 billion in federal Medicaid funding during the next biennium, creating additional financial pressure on healthcare providers across the state. 

“It is a combination of going after revenue opportunities and making some ongoing expenditure reductions that will help us stabilize our operations for the future and be able to weather the storm as HR 1 is causing more and more people to become uninsured,” said Gray, referencing the tax-and-spending bill passed last summer by Congress that includes Medicaid cuts.

“We (community centers) are a vital part of the system of primary care and behavioral health services, preventative dental services within our community, and without these services, our primary care shortage would be significantly worse,” Gray said. “People would become sicker, end up in the hospital more, increase wait times and further destabilize our hospitals financially. Not having access to healthcare is bad for people who are experiencing it and bad for society as a whole.”