Teen clinics fear state budget cuts
Jenny Shipp, family nurse practitioner with Teen Clinic CASA, takes vitals from "Nicole" at the Forestville facility. Gov. Arnold Schwarzenegger's proposed budget could eliminate funding for such family planning and teen pregnancy services
CRISTA JEREMIASON / THE PRESS DEMOCRATPublished: Sunday, February 21, 2010 at 6:50 p.m.
Last Modified: Sunday, February 21, 2010 at 6:50 p.m.
At 19, Nicole has begun to live her life as an adult. She lives on her own, works as a waitress and studies psychology at Santa Rosa Junior College.
But she’s is not ready for pregnancy.
Nicole — who asked that only her middle name be used — said she went to the county public health office on Chanate Road two weeks ago in search of birth control but the office was closed.
She has no health insurance, so she turned to a teen clinic in Forestville to get contraceptives.
“I heard from a friend that this was a really good clinic and that it was a really comfortable environment,” she said last week, shortly after her session with a nurse at the clinic.
The 10-year-old facility offers an array of health care services for teens and young adults up to 25, including confidential family planning, testing and treatment of HIV and sexually transmitted diseases, pregnancy testing, free condoms and emergency contraception, mental health counseling and peer-based sex and sexuality education.
It, and other family planning clinics in Sonoma County, would be crippled if the severest of Governor Arnold Schwarzenegger’s proposed budget cuts becomes reality. In that scenario the clinic would lose 85 percent of its $140,000 budget — a sum that funds services for 1,500 teens.
Under Schwarzenegger’s tiered proposal, Medi-Cal reimbursement rates for many family planning services for the poor and uninsured — rates that were increased in January 2008 and are now equivalent to 80 percent of Medicare, would be rolled back to 2007 levels. The roll-back would save the state $15 million in 2010-11 but would result in the loss of many millions more in federal funding for the programs. The proposal is considered “DOA” in the Democratic-controlled legislature, said Sacramento insiders and family planning advocates.
However, they view as an even bigger threat Schwarzenegger’s proposal to eliminate Family PACT (planning, access, care and treatment) program altogether in next budget year if the state fails to receive almost $7 billion in federal funds the governor has sought, a scenario many government officials think is likely.
According to the Legislative Analyst’s Office, killing Family PACT, which finances teen clinics and many other programs, would save the state general fund $192 million by 2011-12. But would also eliminate nine time more in federal grants because the state pays only 10 percent of the program costs.
“It will mean an increase in unintended pregnancies, an increase in sexually transmitted infections and it will greatly reduce screening for cervical cancer and other preventative screenings,” said Mary Maddux-Gonzalez, the county’s public health officer.
Maddux-Gonzalez said the proposal “short-sighted” and that, “in the not-so-long term — nine months in many cases — we will have increased costs.”
Meredith Kieschnick, associate medical director of Elsie Allen Health Center, said cuts to Family PACT would turn back the clock on significant strides made in recent years in curbing teen pregnancies.
The high school-based clinic, which received $108,000 in Family PACT funds in 2008, is located in south west Santa Rosa, an area local family planning experts refer to as a teen pregnancy “hot spot,” in large part because of extremely high birth rates for Latinas.
According to data from the state Department of Public Health, Sonoma County’s teen birth rate among Latina teens between 15 and 19 has decreased by almost 30 percent, from 79.5 per 1,000 teens in 2003 to 56.8 per 1,000 teens in 2007.
Even so, Latina teens in Sonoma County continue to have birth rates that are more than seven times greater than that of white and Asian teens.
“If we cut back on services, we’re going to start to slip and slide and lose the safety net that we’ve worked so hard to create," said Kieschnick, who also is medical director of the Roseland Children’s Health Center, another clinic run by Santa Rosa Community Health Centers.
Family PACT pays for about half of the 230 monthly medical visits at the Elsie Allen teen clinic, which provides general medical services beyond family planning. The clinic is open Monday through Friday during school hours.
Elimination of Family PACT would mean a loss of $1.3 million for Santa Rosa Community Health Centers family planning services at its two main clinics on Chanate Road and Lombardi Court. Kieschnick said these funds are used to cover a wide range of pregnancy prevention services, from “abstinence all the way to the morning-after pill.”
Kathy Kneer, executive director of Planned Parenthood Affiliates of California, said Family PACT has helped reduce teen pregnancy rates 50 percent since the program was launched in 1992.
She said it was former Governor Pete Wilson, a “pro-choice Republican,” who championed the program.
“He was very realistic about teen pregnancy,” Kneer said. “Telling teens not to have sex doesn't work; it’s not a method of birth control and only works on very young adolescents.”
Planned Parenthood of California has joined other advocacy groups, including California Primary Care Association, the California Academy of Family Physicians and the National Organization of Women, in lobbying the federal government to increase its funding share of the Family PACT program.
California's program is made possible by a waiver to Medicaid rules that allows California to expand family planning services to adults at or below 200 percent of the federal poverty level. It is that waiver the results in the federal government paying 90 percent of the costs and the state 10 percent.
In a letter sent this month to the state’s congressional delegation, family planning advocates asked that the federal government to fund the entire program. The letter states that for every dollar spent on family planning, $4.02 cents is saved on Medicaid.
“You save the cost of labor and delivery for the mother, newborn costs up to 18 months, education costs, welfare costs,” Kneer said.
At the West County Health Centers’ teen clinic in Forestville, staff members said last week that the environment they’ve created for teens is priceless.
Adults who do not work in the clinic are seldom allowed inside. Posters conveying positive messages for teens adorn the walls and the front room is equipped with sofas, music and a refrigerator stocked with food.
“They come in here and they know it’s safe,” said Nichole Clark, the teen clinic program coordinator. “They leave here with the information they need to make healthy choices, informed decisions.”
Each of the 1,500 teens who visit the clinic annually gets a mental health screening and peer counseling. Like Nicole, the Santa Rosa waitress and SRJC student, they come from all over the county, and beyond.
With 85 percent of clinic’s funding coming from Family PACT, elimination of the program would be a devastating blow, said Clark.
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