CLOVERDALE -- Alexander Valley Regional Medical Center recently filed for designation as a federally qualified health center, a move that, if approved, would allow Sonoma County's only certified rural health clinic to receive significantly better reimbursement rates and more operating revenue.

If granted FQHC status, Alexander Valley Healthcare would join numerous other nonprofit North Bay providers who receive a higher reimbursement rate on Medi-Cal and Medicaid patients than other health centers, thus enabling them to provide more services to more uninsured residents, said Deborah Howell, chief executive officer of the health center.

[caption id="attachment_72626" align="alignleft" width="200"] Deborah Howell[/caption]

"We're the only health care provider between here and Ukiah," Ms. Howell said. "We serve both the insured and uninsured. We provide all the same services that the federally qualified health centers provide, except with no resources for the uninsured patients."

Although the health center is not the only safety-net provider in northern Sonoma County, it is the only primary care practice serving the region since the last three private practices in Cloverdale closed in 2003.

Currently, health centers like Alexander Valley Healthcare receive about $37 less for Medi-Cal patients. Obtaining FQHC status would result in additional $40,000 to $50,000 annually just in reimbursements, Ms. Howell said.

Designation as an FQHC would come in the form of an annual $650,000 grant in addition to the increased reimbursement rates, Ms. Howell said. That would boost the health center's annual budget of $2.4 million to $3 million in the first year, a 21 percent increase, and to $3.3 million in the second year, a 32 percent total increase.

The extra funding would mean increased services to more patients living primarily between Cloverdale and Geyserville in northern Sonoma County and the town of Hopland in southern Mendocino -- a region that, like other rural areas, has an acute and well-documented shortage of providers, Ms. Howell said.

Both Cloverdale and Hopland are federally designated primary care "Health Professional Shortage Areas," while the low-income populations in both areas are deemed a "Medically Underserved Population." The area's 16,887 residents are served by 2.8 full-time equivalent of primary care physicians, or a little more than 6,000 people per physician. Alexander Valley Healthcare serves a 561 square-mile area.

The health center served nearly 3,600 unduplicated patients in 2011. If granted FQHC status, that number would increase to approximately 4,000 patients in the first year and up to 4,600 in the second year. The new patients would mostly be uninsured, Ms. Howell said.

More than half of the center's patient base had incomes below 100 percent of the poverty level and 79 percent had incomes below 200 percent of the poverty level, according to the application submitted to the Health Resources and Services Administration, a division of Health and Human Services. The population was 45.9 percent Hispanic, consisting largely of migrant workers in the agricultural sector.  

A host of new services could also be added, ranging from much-needed dental services that were dismantled in 2009 after a lack of state funding, substance abuse treatment, nutritional services and health education, Ms. Howell said.

The new designation would also help the health center conduct community outreach work to its population about enrolling in the forthcoming California Health Benefits Exchange, which was established under the Affordable Care Act to help citizens without insurance obtain coverage through an online market place with federal subsidies.

"That's a critical component going into the Affordable Care Act," Ms. Howell said.

The health center is part of the Redwood Community Health Coalition, a consortium of nonprofit health providers based in Petaluma. It has helped Alexander Valley with outreach coordination, but Ms. Howell said with health care reform coming quickly, it needs a full-time employee to address that issue. The additional funding as an FQHC would enable that.

The health center submitted its application to HRSA earlier this month and is expecting a response by May or June. Should it win approval, FQHC status would take effect on September 1.  It would join the likes of Marin Community Clinics, the Petaluma Health Center, Santa Rosa Community Health Centers, West County Health Centers, Alliance Medical Center in Healdsburg,  Sonoma Valley Health Center, Clinic Ole in Napa and others that serve as the North Bay's safety net as FQHCs.  

It's not the first time that Alexander Valley Healthcare has sought the status, having applied in 2010. Since then, Ms. Howell said the need has only increased, particularly as the state cut health programs significantly in 2009 and 2010 in lieu of the difficult economic environment.

"I'm hopeful but as the same time I'm realistic," Ms. Howell said. "It is nationwide competition. But I know the need is huge up here. I'm hopeful that we'll get the funding.

"If we don't get the designation, the need is still there, but there's no response to it," she added. "We'll do the best we can."