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"Safety-net health provider struggles"

By Claire St. John | Enterprise staff writer | April 23, 2009

Editor's note: One in a series of stories about the state budget crisis' impacts on local services.


Diego Herrera, 5, has his teeth checked by dentist Farideh Tabarsi in April 2008 at CommuniCare Health Centers' Davis clinic.


Diego Herrera, 5, has his teeth checked by dentist Farideh Tabarsi in April 2008 at CommuniCare Health Centers' Davis clinic. Preventive health care like this is important because it helps stave off more expensive treatment later. Wayne Tilcock/Enterprise file photo



Three years ago, Malissa Prado moved to Davis with her two daughters and her husband, a graduate student at UC Davis.

Shortly after they arrived, their youngest daughter developed a low-grade fever.

'We had just moved out here, we didn't have any insurance, I had just started a job,' Prado said.

Prado's boss told her about CommuniCare Health Centers, which provides high-quality health care services to the uninsured, underinsured and indigent population of Yolo County.

Prado's daughter was treated for an ear infection and Prado brought her children back for check-ups and dental care. She even added a new member to her family with the nonprofit's help.

'I went there when I was pregnant with my third child,' Prado said. 'I loved, loved, loved the midwives. I couldn't say enough about them. We've pretty much utilized all their services.'

Prado, 29, appreciated the service so much that she recently became a board member.

'It's an important place because when you don't have insurance, you worry about where you can take your children to get quality care, or where you can be seen yourself and still feel like you're valued and feel that the health care providers are really going to listen to you,' she said. 'That's a big reason why I keep going there.'

CommuniCare, which operates clinics in Davis, Woodland, Esparto, Knights Landing and West Sacramento, began in 1972 as the Davis Free Clinic. Over the years, it expanded into bigger offices near Sutter Davis Hospital and opened satellites. The clinic serves one out of every nine Yolo County residents and last year, it tallied 92,582 patient visits.

Funding for the clinic comes from 75 different sources, said Chief Financial Officer Sherry Cauchois, but money has been drying up as of late.

'All of our state contracts were cut a minimum of 10 percent to 20 percent,' she said.

Compounding problems is the state of California, whose budget is always adopted several months late.

'They rarely pass a budget by July 1 and that affects us greatly because when the budget doesn't pass, we don't get paid,' said Chief Executive Officer Robin Affrime.

Last year, when the state budget wasn't approved until mid-September, CommuniCare had to take out a line of credit to continue operations. It was eventually paid back by the state, but not the $60,000 in interest, Cauchois said.

'That's (equal to) a good-sized grant for services,' she said.

The state also pulled funding for a tobacco prevention program - several months after it was in effect.

'Last year, that one was deleted, but it wasn't deleted until our first quarter of services was fully provided, probably $20,000 of care,' Cauchois said. 'We weren't paid for that, nor will we be.

'It makes planning very difficult,' she said.

Dwindling funds

And then there's the economy.

The state, counties and cities are making cuts, and a lot of them end up on CommuniCare's desk.

Private foundations, equally affected by the stock market readjustment, have curtailed their annual contributions for specific health care services.

The state, trying desperately to close its multibillion-dollar budget gap, is holding on to the money it owes CommuniCare to accrue interest. The checks arrive two, three, four, six weeks later, making it difficult for community health care clinics to balance their own budgets.

'That's our cash flow,' Cauchois said. 'They still owe us back to October. The state is balancing their cash flow problems on the backs of community health care programs. It's inappropriate, which is not really the word I want to use. In my circles, there's a much stronger word that we use.'

With unemployment at a record high and the economy continuing to act consumptive, more people need CommuniCare now, too.

'I think we just went up to 41 percent of the people that we see come in with no private insurance and no qualifications (for state reimbursement),' Cauchois said. 'It used to be around 20 percent.'

Funding for adult dental care also could be cut soon, which is of particular concern to CommuniCare, because dental care is preventive care. Without it, people are more susceptible to disease.

'Preventative health care, over and over and over again, everybody knows it's the lowest cost,' Cauchois said.

Not going anywhere

The only silver lining is that CommuniCare saw this coming, Cauchois said.

'We heard this nightmare was going to hit,' she said. 'We are building up our reserve account. In a couple of years, we'll have a three-month reserve.'

CommuniCare has laid off or left open 56 positions, many of which served now-defunct programs like the tobacco prevention program the state no longer funds.

Patients might be affected a bit, but CommuniCare's mission to serve everyone still stands, Affrime said.

'The truth of the matter is that in some of our clinics we could use more staffing, but we can't afford it right now,' she said. 'That means there's more wait to get in, it means some people will go to the emergency room instead of wait. You are seeing a shift in the community. I know that the people at Woodland Healthcare are seeing visits to the ER double.'

Affrime said community health care clinics need more support now than ever, and in fact, community contributions make up a good chunk of CommuniCare's revenues.

'We really couldn't do it without the support of the community,' Affrime said. 'We need that support now more than ever because we're just getting cut right and left.'

Affrime and Cauchois both said CommuniCare is in no danger of closing, however.

'CommuniCare is always going to be here,' Affrime said. 'We're not going out of business. We have a mission and we're here to serve people that don't have coverage and can't go anywhere else.'

Cauchois said with the health care system in the state it's in, it can't help but get better. But in the meantime, prevention is key.

'I think people better really take good care of themselves, exercise every day, eat right and really take care of their parents and their kids because the system's broken,' she said. 'I think once it starts creeping into the middle class and the upper class, it can't help but get better.'

Until then, CommuniCare will take care of people as long as it can.

'We are the true safety net for health care and we save money,' Affrime said. 'If you can get your care at a primary care setting so you don't need hospitalization, you will save the health care system a lot. There really is a savings. We know that.

'To devastate the safety net at this time just doesn't make sense, because it's going to cost money.'

- Reach Claire St. John at or (530) 747-8057. Comment at

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