Mitigating Disasters’ Health Consequences: A Call for Action for the Community Health Center Trust Fund

Communities across the southeastern U.S. are devastated by Hurricane Helene, as floodwaters block roads, hospitals, and entire towns. In North Carolina, more than 400 roads were closed, blocking access to the major regional health care hub of Asheville and many smaller communities. Individuals perished in the storm, and many are still missing; families are in crisis. In this case and consistently in times of disaster and emergency, community health centers step up to ensure continued access to health care by all means possible. They are uniquely positioned to help based on their long-time role in?bridging gaps between the healthcare system and marginalized communities.

Recently, Cherokee Health Systems (CHS), a federally qualified health center (FQHC) serving 70,000 patients each year in eastern Tennessee, was an example of this in action. CHS staff can be found distributing food and water and staffing mobile clinics to impacted communities. They are also sending units to reach people with limited access to health services and medicine in areas of the state that remain devastated and largely closed off from regular access to care. Mountain Comprehensive Health Corporation, an FQHC located in western Kentucky, has also been delivering essential supplies to affected areas daily to pay it forward for the generosity they experienced from catastrophic flooding in July 2022.

Research has shown that the poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden during disasters. Ensuring that our nation’s 1,400 community health centers continue to serve as safety-net providers for those who need it most is critical for mitigating disasters’ health consequences and promoting health equity.

The Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule outlines the expectations for CHCs to develop and maintain emergency preparedness plans and requires health centers to coordinate with state and local health departments as part of their emergency management planning, preparedness, mitigation, and response efforts.

Yet, funding for the Community Health Center Trust Fund, approximately 70% of program funding, is set to expire December 30, 2024, with no plan in place for what comes next.

In addition, the Health Resources and Services Administration (HRSA) has no emergency spending authority?or budget line item for disaster relief for health centers. When margins are too thin—the average margins for health centers nationally are 1-3%—and our federal partners have limited resources that must be spread across an expanse of needs, stakeholders, and partners, CHCs are stretched even further. And when disasters strike, CHCs are stretched to near-impossible levels.

Health centers need adequate and sustainable funding to be able to plan for, and continue to respond to, an ever-increasing number of emergencies and disasters.

The time to act is now. At minimum, Advocates for Community Health (ACH) urges Congress to reauthorize the Community Health Center Fund at $5.8 billion a year for at least three years and to allocate $3.2 billion in discretionary funding in fiscal year 2025 through the yearly appropriations process. This funding will help health centers stay afloat while allowing them to respond to the ever-increasing need to serve their communities in emergencies, expand access to care, and invest in climate-resilient infrastructure.

ACH also urges Congress to provide specific funding to HRSA to support disaster and emergency response. As the agency of oversight for the Health Center Program, HRSA is already structured and practiced in triaging the needs and coordinated response of health centers in times of emergency. However, this work has been done without any resources to support health centers serving communities on the ground. This is particularly troubling given the increasing frequency of disaster/emergency scenarios and the continued role that health centers play to care for those in need, those impacted, as well as those who arrive to help, in real time.

As climate change continues to exacerbate the severity of natural disasters, which disproportionately affect vulnerable populations, mitigating disasters’ health consequences is more important than ever to protect the health of our communities. Health centers are a proven solution with a near 60-year track record of success, strong bipartisan support, trust, and appreciation within their community—the largest network of primary care providers in the nation.

The irresponsibility in the lack of action to provide long-term sustainable funding is that much more visible in times of emergency. The sad and disturbing question is – what is Congress waiting for?