NORTH BAY — While community health centers are widely seen as winners with the passage of a sweeping health bill in late March, such centers in California face potentially crippling state budget cuts, which could offset potential gains that won’t take effect until 2014, according to clinic directors throughout the North Bay.

In an attempt to offset portions of California’s budget deficit of $20 billion, Gov. Arnold Schwarzenegger has proposed deep cuts to services at community health centers, while the federal Patient Protection and Affordable Care Act promises to deliver scores of previously uninsured patients to clinics, thus increasing the need for services amid a dire state economy.

Funding for clinics will increase significantly at the federal level, with $1.5 billion becoming available over the next five years for clinic expansions in California, according to the California Primary Care Association.

“It’s kind of a narrow passage from now until the health bill is implemented,” said Mary Szecsey, executive director for West County Health Centers, referring to $11 billion that will be distributed to federally qualified health centers nationwide as a result of the health bill. “We certainly hope to see some of those funds because we are expanding, and we know that we’re going to have more facility and staffing needs.”

Ms. Szecsey said the biggest impact for West County Health Centers would be the elimination of FamPact funding, for which the state receives 90 cents on the dollar from the federal government. “But the governor is contemplating eliminating that 10 percent,” Ms. Szecsey said, adding that West County’s teen clinic in Forestville, which serves about 1,500 youth a year, would face closure should the cuts be borne out, thus losing access to STD prevention services, preventative pregnancy care and other services.

Santa Rosa Community Health Centers Executive Director Naomi Fuchs said cuts to Adult Day Health Centers could have dire consequences for the region and the state. The state estimates it will save $104 million from the ADHC cut, according to the primary care association, which described the savings as “false” because it leaves approximately $216 million in federal matching funds on the table and would drop 37,000 individuals statewide from the program

The proposed cuts would “close the only day health center in the North Bay,” she said.

Cuts to the FamPact program for the Santa Rosa Community Health Centers would translate to a loss of approximately $1 million in revenue for medical services such as women’s annual exams and cancer screening, among others, Ms. Fuchs said.

Beatrice Bostick, executive director for Clinic Ole in Napa, agreed that the simultaneous arrival of the health bill and state cuts have put health centers in an interesting bind.

“Most of the effect of health care reform will be positive on community clinics,” she said. “We expect a huge demand for access as health care reform implements insurance pools and expansion of Medicare to 133 percent of the poverty level.” She added that Clinic Ole anticipates that 70 percent of its currently uninsured patients will be insured by 2014, when most of the provisions of the health bill take effect. Currently, 65 percent of 15,000 Ole patients are uninsured.

John Shen, executive director for Marin Community Clinics, said most of the effects from the health bill remain unknown but noted some positive developments while cautioning that health centers, like all health care providers, will be dealing with a new reality.

“We understand the extremely low California Medicaid rate will be moved up 100 percent,” he said. “This removes a major barrier for private physicians who in Marin County have not been able to care for the Medi-Cal population.”

But he said it remains to be seen if there will be improvements in Medi-Cal reimbursement for specialists.  If they do not change, “the barrier is still there, and patients will have no choice to continue to use the emergency department of local hospitals as an access point for specialty care.”