Portland officials are questioning the loss of a federal grant that could force the city’s health clinic for the homeless to close, and leave 1,300 people without access to health care.
The $680,000 grant was awarded instead to the Portland Community Health Center, which city officials say violated a contractual agreement by applying for the grant. The loss leaves a critical hole in the city clinic’s $1.8 million annual budget, officials say.
The independent, nonprofit Portland Community Health Center was launched in 2009 with federal stimulus funds. The city helped to run and pay for the health center until 2012, when the nonprofit assumed full control.
When they split, the city and the health center made a formal agreement not to compete for certain federal grants, including the health care grant to serve the homeless.
Mayor Michael Brennan said the health center “clearly violated the spirit and intent of the decoupling agreement” when it sought the grant for this year.
Officials say the city also is still owed money by the health center.
Leslie Brancato, executive director of the health center, said the non-compete clause applied for just one year and did not apply in this case because the city’s grant application was rejected in an initial scoring round, before the community health center applied in a second round.
“The important thing here is making sure the services are there for the people who need them,” Brancato said.
For the past 20 years, Portland has received the grant without competition. Last year, the federal grant money accounted for nearly $670,000 of the clinic’s $1.8 million budget.
When the city’s application for this year was rejected because of a clerical error, Brancato said, the health center sought to preserve about $680,000 for services in the city. It beat out the city in the second, competitive round of applications, scoring 97 out of 100. The city scored 88.
Brennan said the city was never at risk of losing the funding. Its second application corrected the error, which placed a number in a wrong box, he said.
The applications are reviewed by an objective, independent panel of experts related to the program, said Martin Kramer, spokesman for the U.S. Department of Health and Human Services’ Health Resources and Services Administration. There is no formal appeal process.
“As a matter of grants policy, we do not discuss publicly the make-up of the Objective Review Committees or their reasons for scoring an application the way they did,” Kramer said in an email.
SHIFT OF FUNDING CALLED ‘SHAMEFUL’
Brennan said the city has filed a public records request for the scoring criteria and full results, as well as the Portland Community Health Center’s application.
That information could be the basis for a federal lawsuit challenging the award, he said. “We are evaluating all of our options at this point,” Brennan said.
About 2,300 people who lack insurance or money to pay for medical care are served at the city clinic, which has a staff of about 30. The community health center intends to use the grant money to immediately serve an additional 1,000 patients. That means about 1,300 patients will lose access to care if the city clinic closes, something city officials say is possible.
Mark Swann, executive director of Preble Street, a nonprofit agency that runs shelters and soup kitchens, condemned the grant award in a letter to Brennan, Maine’s congressional delegation and the U.S. DHHS, dated Jan. 6.
“The loss of that funding is nothing short of shameful,” Swann wrote.
The city has been running the Health Care for the Homeless clinic since 1989. Swann said Preble Street raised more than $1 million a decade ago so the clinic could be housed at the Preble Street Teen Center, near the agency’s day shelter and soup kitchen.
Although the community health center serves a broader population, the city clinic serves the chronically homeless, whose cases are complicated by mental health and substance abuse issues, Swann said.
The community health center is at 180 Park Ave., a half-mile from the city clinic at 80 Portland St. and nearby shelters and soup kitchens.
“Getting an intoxicated, incontinent adult homeless male to a clinic further away than simply across the street will be challenging enough,” Swann wrote. “Having a client/patient then wait in a crowded waiting room with immigrant/refugees families with children in tow will prove impossible.”
Brancato said the community health center would like to work with the city and other service providers to find a way to cover all of the health care needs of the homeless, some of whom already go to the center.
The number of homeless people served by the center – mostly families – increased from 71 in March 2012 to 626 in September 2013. The center serves about 4,300 patients in all.
Brancato said the center’s three-year plan includes opening a new location. That could be at Preble Street, she said, or in a mobile clinic.
COMPARING GRANT BID SCORING
The city and the community health center provided the scoring summaries from their grant applications to the Portland Press Herald.
The health center outscored the city in governance, financial stability and the use of electronic health records. The only weakness cited in its application was an unclear delineation between the population it serves now and the targeted population of homeless people.
Brancato cited the strength of the center’s directors, most of whom are patients, including two board members who have been homeless.
The community health center scored well on its financial stability, although Brancato conceded that it overspent its budget by $268,000 last year.
“This year we expect to be in the black,” she said.
Brancato acknowledged that the center may owe the city money. Brennan estimated the debt is “hundreds of thousands of dollars,” but Brancato said it is closer to $55,000.
The city’s clinic, meanwhile, has struggled with its governing structure. Until this summer, the program operated without a federally mandated board of directors. The City Council is filling that role until a permanent board is formed.
The city’s application lost points because of its “minimally attended consumer advisory board in order to ensure patient input and/or appropriate project oversight of the governing board,” according to a grant grading summary.
Other cited weaknesses included a lack of clinic space and a lack of resources to expand. Also, the city was not clear about its hours of service, the summary says.
Randy Billings can be contacted at 791-6346 or at: