Portland City Manager Jon Jennings has proposed keeping the needle exchange and HIV/STD services open at the city’s India Street Public Health Center site for six months longer than originally planned. The move comes amid public concerns that at-risk patients will fall through the cracks during the turnover, and would buy the city more time to transition those services to the nonprofit Portland Community Health Center.
The closure of the city’s India Street clinic has been the most controversial aspect of Jennings’ proposed $236 million budget for fiscal year 2017. The original plan called for the facility to shut down by Jan. 1, 2017. Now, he told the City Council’s Finance Committee in a Thursday memo, he’s asking for the clinic to continue offering at least some of its services until June 30, 2017.
With Jennings’ changes, the City Council’s Finance Committee OKed the plan on Thursday, putting it another step closer to final approval by the full council.
Jennings has argued that the Portland Community Health Center qualifies for much higher rates of state and federal reimbursements than the city’s facility, so more health care dollars will be flowing into Portland and — by extension — those services will be more robust. He’s also noted that Portland has long been an outlier by providing direct health care services, with most or all other New England cities just overseeing the services of private or nonprofit subcontractors.
But those arguments had failed to calm fears that the closure of the India Street facility will crater health care access for some of the patients who need it most.
A big criticism has been the lack of public details about what could be a nerve-wracking transition of services from one facility to another, with the rocky 2014 closure of the city’s Health Care for the Homeless Clinic in favor of this very same PCHC casting a long shadow over the debate.
(In that case, the transition was a somewhat forced one, as the health center competed with the city for limited federal grant money and won. City officials protested the PCHC’s competition for the federal funding and only closed their clinic begrudgingly.)
“It is personal. It affects a lot of us,” Chris Berkley, a local patient told the Finance Committee of the proposed India Street closure Thursday, according to the Portland Press Herald. “It’s really shocking to me you’re going to take this service away and I don’t trust where it’s going.”
“If there’s a way to better serve people, I’m all for it, but I question closing a clinic that’s in the neighborhood of the people who potentially could receive life-saving care there,” said another, according to local NBC affiliate WCSH 6.
“I completely understand the emotion,” Jennings told the BDN Friday morning. “Change is hard for many of us. I get why some people are opposed and why they think it’s not a good move, but this is a very thoughtful move and city staff have looked at this from every possible angle.
“I would never have proposed this if I’d thought there was a danger of people being displaced or falling through the cracks,” he continued. “I do have great confidence in the Portland Community Health Center’s ability to follow through with all the patients do decide to go there.”
Jennings said he believed the city and health center would have been able to make a successful handoff of services by the end of the calendar year, but he said adding six months to the schedule will allow the organizations to be even more meticulous.
Concerns about grants
Jennings said Friday the city may lose nearly $700,000 in health care funding due to changes in the way the state plans to administer Healthy Maine Partnerships grants — awarding just a few statewide organizations, as opposed to directly funding local agencies.
The federal government is increasingly prioritizing specially designated Federally Qualified Health Centers for funding over municipalities, he said, adding that he was worried the Ryan White Program grant money currently fueling the India Street clinic’s HIV services could be lost in future years if that trend were to continue.
With the city’s capacity to deliver direct health care services being undercut by grant losses and the prospect of more federal grant losses on the horizon, Jennings said making a transition to the federally recognized Portland Community Health Center now allows the city to be proactive instead of reactive.
The concern about the Ryan White grant is speculative, of course, and the city will still have some opportunities to access Healthy Maine Partnerships money as a sub-grantee from whichever statewide organizations are awarded the funding initially. But Jennings said he sees enough writing on the wall to warrant handing direct clinical services over to someone with more stable footing in the eyes of federal purse holders.