As a follow-up to the analysis of the financial impact of COVID-19 on California’s Federally Qualified Health Centers,1 Capital Link evaluated whether the size, number of sites, payer mix, service mix, or location may have created a differential financial impact on specific groups of centers. The findings of this analysis are summarized below.
Based on these findings, there is significant risk that the health center system in California will be greatly weakened in a postpandemic future, absent additional funding support — especially for the largest centers. While federal support is on the horizon, it will be important to pay close attention to the financial health of these health centers if California hopes to preserve the integrity of the safety net.
The centers that had the most capacity prepandemic, and those that serve 68% of all patients and 69% of Medi-Cal patients overall, face the most financial risk. They are on track to emerge from the pandemic in a significantly weaker financial position than before the pandemic, potentially curtailing their ability to “bounce back” to provide the range and volume of care they were previously providing.
Smaller centers may fare somewhat better, given they entered 2021 in a stronger financial position — however, given the unknown course of the pandemic, they too may experience significant losses going forward without additional resources to offset COVID-19-related costs and losses through at least 2021. It is important to note that relief funds received through December 2020 were intended to cover costs well into 2021 — so any “surpluses” experienced by some centers through December 2020 may ultimately be used to cover pandemic-related losses in 2021.
Whether measured by revenue size, number of patients, or number of sites, the largest health centers bore the brunt of the financial losses between April and December 2020.
- By revenue size: The top quartile,2 with revenues in excess of $36.7 million in 2019, absorbed 95% of the losses, totaling approximately $557 million (an 11% operating loss), while the lowest two quartiles, with revenues below $16 million, had combined surpluses totaling $64 million (an 8% operating gain).
- By number of patients: The top quartile, with more than 31,000 patients in 2019, absorbed 97% of losses, totaling approximately $547 million (a 12% loss), while the lowest quartile, with fewer than 6,500 patients, had estimated surpluses totaling $41 million (a 17% gain).
- By number of sites: The top quartile, with 14–52 sites, absorbed 91% of losses, totaling $506 million (a 12% loss), while those with three or fewer sites had collective surpluses of $32 million (a 5% gain).
Centers that serve the highest proportion of Medi-Cal patients sustained almost all of the financial losses, totaling an estimated $549 million.
- 96% of the losses were concentrated in the top quartile — those centers serving between 20,266 and 243,421 Medi-Cal patients in 2019. This group sustained average losses of $145 per patient, based on 2019 total patients.