Shelly Ten Napel

CEO, Community HealthCare Association of the Dakotas

Sioux Falls, SD

It is a tough time for health care providers right now. Staffing shortages are increasing across North Dakota caused by long-standing provider scarcity and made worse by pandemic-related burn-out. The biggest cost for all health care providers is wages. Wages have increased dramatically over the last few years from entry-level staff to high-level providers, and reimbursement and other funding have just not kept pace.

Community health center advocates are working hard at the Capitol this legislative session to make a case for the value of the care we provide and the need for additional state support to sustain and continue to grow our impact across North Dakota. That sounds great, you may say, but what is a community health center?

In a nutshell, community health centers (CHCs) are non-profit, patient-governed health care providers with a mission of filling gaps in the current health care system. In rural areas, that might mean providing access to care in places where it might not be financially viable to sustain local primary care. In urban areas, it usually means providing care to underserved populations such as individuals facing housing insecurity, low-income working families, or those best served in a language other than English. In 2021, North Dakota CHCs provided high-quality, cost-effective medical, dental, behavioral health, and school-based care to over 36,000 individuals at 21 delivery sites in 19 communities.

Community health centers – by mission and program requirements – see all patients regardless of insurance status or ability to pay. Health centers provided nearly $11 million in uncompensated care over the last legislative biennium. At the same time, they saved other providers and state money by providing a model of care that keeps patients healthy and out of the emergency room.

Because of the unique role health centers play in filling gaps in the health care system, 29 states currently allocate funds to support their mission. Recently, North Dakota legislators heard directly from health center executives about how they would use additional resources from the state. Spectra Health talked about the lives they have saved through the centers’ opioid treatment programs. Family HealthCare described a mobile van equipped with dental equipment that can travel to meet the dental access needs of underserved populations in Fargo and beyond. Northland Health Centers discussed expanding access to behavioral health services in communities with very few local providers. In general, this state funding would help health centers respond to workforce challenges and shortages, enable health IT investments that support quality improvement, put more resources towards social and environmental barriers to health in underserved communities, and sustain outreach, translation, transportation, and other non-billable services.

To learn more about community health centers and their impact on your community, visit the Community HealthCare Association of the Dakotas’ website or social media pages and join the movement to ensure access to high-quality health care for ALL North Dakotans!