Should Health Departments Still Provide Clinical Services Post-ACA?

This study was undertaken to test a simple decision support tool in order to facilitate local conversations regarding the provision of clinical services by health departments and whether or not it made sense to seek reimbursement for those services.

The decision whether or not to provide clinical services is treated as a supply and demand problem using a two by two matrix. A health department is positioned in one of four quadrants based on whether or not the state in which it is located is expanding Medicaid (demand) and whether or not the county in which it is located is a designated primary care health professional shortage area (supply). Combinations of the two variables were combined and plotted on a county-level map in four categories: 1) No Medicaid Expansion/No HPSA (Medium safety net role/Low opportunity to pursue reimbursement), 2) No Medicaid Expansion/ HPSA, (High safety net role/Low opportunity to pursue reimbursement), 3) Medicaid Expansion/No HPSA (Low safety net role/Low opportunity to pursue reimbursement), and 4) Medicaid Expansion/HPSA (Medium safety net role/High opportunity to pursue reimbursement).

There were 3,115 valid listed counties. 249 (8%) were in category 1, 1,609 (52%) were in category 2,184 (6%) were in category 3, and 1,073 (34%) were in category 4.

According to this simple analysis, health departments in only 6% of counties might be in a position to consider discontinuing clinical services; and, health departments in only 34% of counties may have a high opportunity to seek reimbursement for those services. Because there may be at least a medium safety net role for health departments in 94% of U.S. counties, the question of whether or not to continue to provide clinical services should be considered carefully.