Delayed reimbursement to clinics that provided mpox vaccine

By Kristen Hwang, CalMatters

Seven months ago, California battled its second ever widespread epidemic — mpox, Formerly called monkeypoxCases spread exponentially, primarily among the state’s male LGBTQ population, Officials struggled to deploy limited vaccine supplies from the federal government.

Community clinics and LGBTQ health centers set up large-scale mpox vaccination sites as soon as possible and sought support from local and legislative leaders, but often Red tape at both federal and state levels hampered rapid response.

Today, as the federal government lifts the mpox emergency, those clinics say bureaucracy is looming again. State and federal reimbursements for services, possibly in the millions of dollars, have yet to be approved and could take months.

“We don’t know what the holdup is,” said Craig Pulsipher, former director of government affairs at APLA Health, a clinic in Los Angeles that specializes in LGBTQ people. APLA Health has administered more than 4,000 vaccines. and one of the largest vaccination providers in the city. $83,000 grant for mpox While working for the state’s AIDS department, he spent “hundreds of thousands of dollars” on vaccinations and shifted funds from other programs to response efforts.

parliament released $41 million emergency funding Of last year’s mpox response efforts, half remained in state public health departments. About $1.4 million has been donated directly to community organizations that directly support vaccine efforts, but the organizations say they don’t have enough to cover the costs.

The vaccine itself was provided to states free of charge from the federal stockpile, but community organizations distributing the shots had to invest staff time, equipment, and other resources to respond. Immunizations and other minor procedures are typically billed as part of a “provider visit”, which requires a doctor’s visit and is not a large It does not occur in vaccination campaigns.

Instead, the country petition the federal government Use your Medi-Cal dollars to reimburse for a single vaccine to try and recoup some of your labor costs. Medi-Cal is a state insurance program for low-income individuals funded by state and federal funds.

Dr. Ward Carpenter, Chief Health Officer of the Los Angeles LGBT Center, said: “We could barely keep the emergency department open for anything not mpox related….it was at least as busy as it was in the early days of COVID.

Carpenter said the LGBT center has distributed more than 6,500 vaccines and has more than $500,000 in outstanding payments. In November he received her mpox grant of $116,000 from the AIDS office.

In September, the California Department of Health and Medical Services submitted to the federal government request a refundShortly after, members of the California legislative delegation, led by Democratic Rep. Jimmy Gomez of Los Angeles, said: letter Urge the U.S. Department of Health and Human Services for timely approval of the request.Community clinics, which often serve as safety nets for poor and undervalued patients, had little room for financial adjustment and already had to. Wait 2 years to pay for COVID-19.

“Your prompt and urgent attention to these requests will help enable our district’s critical providers and community clinics to continue their vital work,” the letter read.

Gomez’s office asked APLA Health in November whether additional pressure on federal partners would help, Pulsifer said, but state officials were confident the approval was coming soon, so the organization didn’t approve at the time. rejected him with

“What we heard[from the state’s Department of Health Services]was that they were moving forward and they didn’t need that kind of pressure,” Pulsipher said. not.”

The department told CalMatters that the federal government must approve California’s plan to use Medi-Cal dollars for MPOX reimbursement. The federal government sent out state comments and proposed amendments to the plan in December, with a 90-day review period. The clinic will eventually be able to claim payment for the services he provided as far back as August, when mpox was at its peak, but the more time passes, the more overburdened staff bills retroactively. Less likely, he said, Pulsipher.

“It takes a very long time to go back and file those claims,” he said. “Some clinics do that, and probably others don’t.”

Mpox Outbreak Today

California reported First mpox case in Sacramento May last year. What started as an isolated travel-related infection quickly ballooned into a statewide outbreak, and in August he peaked at 145 cases in a single day. according to state dataCalifornia has reported more than 5,700 cases, more than any other state. first death in the country.

“It would be hard to overstate how frenetic, enthusiastic and all-consuming it was compared to back then,” Carpenter said.

In stark contrast, there were two cases reported on January 10, the most recent data available.

State officials have not set an end date for California’s state of emergency, but an unsigned email from the media department said that public health has been tasked with regular monitoring and response with the sexually transmitted disease control department. I am planning to transfer to the AIDS department.

“Once cases are reduced, outbreaks are under control, and public health components for a robust response are fully operational, the impact on providers,[local health jurisdictions]or patients from the end of the emergency will There shouldn’t be,” the email said. Said.

But ending the emergency does not mean “the end of the disease,” Carpenter said. Many LA LGBT center patients are vaccinated during routine doctor visits, but are often unaware of outbreaks and the need for protection.

“The virus hasn’t gone away. It’s not surging right now, but it’s not gone, so there’s a risk of it coming back,” Carpenter said.

APLA Health’s Pulsipher said his organization is working hard to educate and vaccinate Black and Latinx patients.

“It’s important to stay vigilant,” he said.

Blacks and Latinos in California account for 58% of all mpox cases, but only 33% of all vaccinations. according to state data.

“What has become clear between COVID and mpox is that poor access to healthcare for one person affects all of us,” Carpenter said. “Again, this is why we are not stopping these vaccines and returning to business as usual. Even within our own communities, we still have a lot of work to do. I know.”