
Whether or not you have health insurance, you can visit a federally qualified healthcare center (FQHC), also known as a community health center, a medical clinic funded in part by the federal government. Its main purpose is to provide access to medically underserved communities so vulnerable populations can access healthcare. Services provided include not only adult and pediatric primary and preventative care but also dental services, mental and behavioral health, podiatry, chiropractic, women’s and reproductive health, cancer screenings and the Ryan White HIV program to screen and care for people with HIV.
Dr. Ian Leber, chief medical officer for Visiting Nurse Association of Central Jersey Community Health Center, which has locations in Red Bank, Freehold, Asbury Park and Keyport, discusses the importance of FQHCs and why it’s important for everyone to be aware of their mission.
New Jersey Family: How is a federally qualified healthcare center similar to or different from a typical standard doctor’s office?
Dr. Ian Leber: As a patient, the care that you receive is probably equivalent. We have physicians, we have nurse practitioners. The difference is that we are not a for-profit model and we are driven to provide care and are not driven by profit.
The other differentiator is we focus exclusively on outpatient care. We have one purpose, and it’s to see patients in our offices and keep them healthy.
Our goal is to be as accessible as possible. We offer appointments but we also accept walk-ins. We’re open late certain evenings during the week and also offer Saturday hours.
NJF: We know that healthcare costs continue to increase every year for families. What are the estimates of how many families and individuals in New Jersey are without coverage?
Dr. Leber: It’s really a difficult question to answer completely accurately because we have a large number of undocumented residents and a significant migrant population here in New Jersey. The latest estimates through the New Jersey Department of Health, and these go back to 2020, estimated that there were about 600,000 residents in New Jersey who didn’t have insurance. That equates to about 8% of the population, but it’s not evenly distributed.
For example, in that same measurement period, 19% of Hispanic New Jersey residents were uninsured, and 9% of African-American New Jersey residents were uninsured, compared to only 4.8% of White New Jersey residents. There are still significant health disparities across the state, and I think you’ll see those numbers repeat across the country.
ScreenNJ is a statewide service the provides education about cancer prevention and detection to the community and for professionals. ScreenNJ supports NJ residents to obtain cancer screening regardless of ability to pay. For more information about ScreenNJ visit screennj.org.
NJF: Since you provide care for people who are uninsured, where does the funding come from?
Dr. Leber: Our main source of funding is what’s called Section 330 funding, and that’s from Section 330 of the Federal Public Health Services Act, which is made available through the federal government via HRSA (Healthcare Resources Service Administration). We get a fixed amount of funding every year that we must qualify for. We have to submit data to show that we’re meeting the requirements in order to qualify for that funding and we apply for renewal every 3 years. However, this funding doesn’t cover nearly all of our costs to provide services. We also rely on donations. We rely on insurance payments from our patients who do happen to have health insurance, as well as our sliding scale fee system for patients who do not have insurance to help narrow that shortfall and allow us to continue providing services.
NJF: Can you elaborate on the sliding fee scale?
Dr. Leber: Part of being an FQHC is that you must have a sliding scale fee schedule. That is how patients who don’t have insurance pay for services. It is a heavily discounted rate that is based on both the size of your family and your total household income. When patients come in, we will determine their eligibility as part of the registration process. Some screening services are completely free based on grants from other sources, but most services have some small fees associated with them. It could be as low as a couple of dollars depending upon your circumstances.
For someone who absolutely cannot afford anything at all, we will work with them to get them the services they need, whether it’s us being able to provide it directly or possibly referring them to a free clinic in the area.
NJF: You also see patients who are insured?
Dr. Leber: We will gladly take care of patients with commercial insurance, and we found that those patients with insurance who try us really like us because of our practitioners, the ease of accessibility and the welcoming environment.
NJF: Why is healthcare access so important, especially when it comes to medically underserved populations, and especially when it comes to cancer screenings?
Dr. Leber: Access is critically important because prevention of illness is the key to improving not only lifespan but quality of life. Medically underserved populations often have to deprioritize preventative care due to the other more pressing matters in their lives. We work very hard to reduce the barriers to accessing preventative care. Regarding cancer risk specifically, we know that everyone is at risk for cancer. There are many reasons for this, including environmental factors, poor diet, obesity, smoking, genetics (which we have no control over) or just unfortunate lifestyle choices. Sometimes it’s just bad luck. But cancer is a risk for everybody.
The good news is that for the most common forms of cancer – breast, lung, colon and prostate – we have screening tests. We work very hard to detect those early and treat them before they cause a problem, but people have to come in and allow us to perform these screening tests. It’s always difficult for people to make time to get tested when they are feeling well and are probably not even thinking about their risk of developing cancer.
We provide cervical cancer screening in the form of Pap smears. We have relationships to obtain mammograms for our eligible patients. We provide colorectal cancer screening, as well as prostate screening. All of these tests are included in our primary care services. For our patients, we keep track of who’s had their screenings and who is due so we can make sure that everyone gets the recommended screenings as they come due and have the best chance of catching the disease early when it’s easiest to treat.
Interested in learning more or getting screened but not sure where to start? Contact ScreenNJ patient navigators for free help scheduling your cancer screening regardless of your income or health insurance status. Email patientnavigation@cinj.rutgers.edu or call (833) 727-3665 or text SCREEN to 43386.
NJF: We know that people without insurance tend not to get preventative care, which includes these important screenings that you’re mentioning. Do you have any statistics or outcomes that you’re seeing in these medically underserved communities when it comes to cancer rates, for example?
Dr. Leber: We’re very fortunate that over the past 20 years, there have been a lot of advances in the detection and treatment of cancer. The rate of new cancer diagnoses and deaths from cancer has declined across the population, which is great news.
The less great news is that the medically underserved communities that we serve are not seeing the same improvements in outcomes. If you look at our National Cancer Institute data, we still see that the African-American population has higher death rates than all other racial and ethnic groups for just about every cancer type, which is terrible and something we can help address.
Despite having similar rates of breast cancer in African-American women compared to White women, African-American women have a much higher incidence of dying from the disease. They’re not getting diagnosed early enough which means they’re not getting the treatment when it could help them the most. African-American women and Latino women both have higher rates of cervical cancer than women of other racial and ethnic groups. Again, African-American women have the highest rates of death from cervical cancer. Increased screening and early detection can help reduce these disparities.
NJF: What are some of the factors that contribute to these statistics?
Dr. Leber: It’s believed that a large factor is the lower incidence of screening and early detection. People in underserved communities and communities of lower socioeconomic strata tend to be diagnosed with later stages of cancer, which makes it harder to treat and increases the risk of mortality significantly. I believe education plays a big role in improving health. People with higher levels of education are statistically less likely to die prematurely from colorectal cancer than those who may not have as much education. That’s regardless of race or ethnicity. We know that smoking and alcohol use increase cancer risk. The rates of engaging in those activities are higher among our lesbian, gay, and bisexual populations than among heterosexuals. That increases their risk for cancer disproportionately.
We also know that people who have lower incomes typically have lower health literacy. Health literacy is defined by the CDC (Center for Disease Control and Prevention) as the degree in which someone can find, understand, and use information and services to inform health-related decisions and actions for themselves or others. It’s harder for those with lower health literacy to know about how, when and why to get screened. Those who live in lower-income neighborhoods tend to to travel longer distances to see a healthcare provider. This is another barrier to care.
People who work in lower-wage jobs tend not to have paid medical leave. It’s more challenging to take time off work to go get these preventative healthcare services and screening tests.
We also take care of people who speak different native languages. Spanish is certainly very common, but we also have a large Haitian population whose native language is Creole. These language barriers are real. We have many employees who are multilingual, which is a help. We also employ interpretive services, so that we can communicate with anyone regardless of their native language.
The other challenge we have that’s related to not being a native English speaker is trust. We welcome everyone regardless of their immigration status, ethnicity, race, gender or sexual orientation. We firmly believe everyone deserves care. Addressing concerns that coming to us for care is somehow going to jeopardize your safety or ability to remain in this country is something we face daily and we work very hard to make sure everyone knows that we are a place where everyone is welcome.
Thinking about screening for yourself or someone you love? Start by talking to your primary care doctor about screening options or contact ScreenNJ, a cancer prevention, screening, and early detection program brought to you by Rutgers Cancer Institute of New Jersey, the NJ Department of Health, and healthcare and community organizations statewide.
NJF: How else do FQHCs foster inclusivity?
Dr. Leber: Our mission is to serve everyone in our community. There are many different groups that have historically felt unwelcome in the traditional medical model. Through training and education, we work to be a place where everyone feels comfortable. In addition to training for all of our employees, we also have a dedicated LGBTQ+ health program so that we can create an environment for members of the LGBTQ+ community to feel welcome and comfortable coming to seek medical care. We offer offered gender-affirming care for members of the transgender community. We will help them with gender-affirming hormone treatment and related services to get them the healthcare they need to live full and happy lives.
Then we also have a wonderful program to help people who are suffering from opioid use disorder. We offer medication-assisted treatment for those looking for treatment for opioid dependence but also have programs that will provide services to help those who are not ready to stop using. This includes Narcan to treat an overdose as well as test strips to ensure their drugs are not contaminated with Narcan or other contaminants. If we can help people be safe, then we will do what we can.
NJF: How do you reach people in these communities so that healthcare is accessible to them?
Dr. Leber: We do a lot of outreach, educational sessions, and social media. We partner with other community organizations, including religious organizations and other community service organizations. All of our materials are available in several different languages so that we don’t disenfranchise anyone who may need our services. We have mobile clinics where we go to different locations and provide mobile screening services. We certainly maintain an online presence. Our employees are members of the communities we serve, so they are our greatest ambassadors: going out and talking about what we do, how we do it and how wonderful FQHCs are helps spread the word that we are here to help.
NJF: What should be done to incentivize people in communities that have been historically medically underserved to seek out preventive care?
Dr. Leber: We understand that preventative care often has to take a back seat to more pressing needs, like paying the rent or feeding your family. We want everyone in our communities to know that we’re here to support them and work with them, so we always speak to the members of our community. We also do a lot of work to learn about the other needs people may have. For example, if you’re having housing challenges, if you’re having challenges paying your utility bills, we have connections to resources that can help you with that.
NJF: When it comes to access to quality care and those who need it most in New Jersey, what are your biggest hopes for the future?
Dr. Leber: I hope that we continue to address the healthcare disparities that exist and do whatever we can to ensure that there is equitable access to quality care for everyone in this state regardless of socioeconomic status, education status, or immigration status. We want all New Jerseyans to have equitable access to care. We need to continue investing in community health initiatives, expand funding so that we can help more people and find ways to let everyone know that community health centers exist and that anyone can come to us.
I would love to see even greater collaboration between healthcare providers, community organizations and policymakers so that we can address social determinants of health and create healthier communities. That would be an incredible accomplishment! Treating people when they’re sick is important, but preventing them from getting sick in the first place is truly the ultimate goal.
Dr. Ian Leber, MD, MBA, CPE, FACEP, is the chief medical officer for the Visiting Nurse Association of Central Jersey Community Health Center.
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ScreenNJ is a statewide service that provides education about cancer prevention and detection to the community and professionals. ScreenNJ supports NJ residents to obtain cancer screening regardless of their ability to pay. For more information about ScreenNJ visit screennj.org.