Uninsured and diagnosed with HIV in 2004, Northeast Baltimore resident Dorothea Townes visits Chase Brexton Health Services' Mount Vernon clinic at least once a month to pick up medications and get checkups.
"It's a big difference," Townes, 49, said of the personalized treatment she receives compared with the care her friends get at hospitals.
Community health centers such as Chase Brexton are about to play a far larger role in the nation's health care when the federal health reform law is fully implemented in January.
The Affordable Care Act includes $11 billion to be awarded to community health centers over five years to build new clinics and expand existing ones. By 2015, the health centers are expected to double the number of patients they serve to 40 million.
Maryland health centers — which last year served nearly 300,000 patients, many needy and uninsured — are bracing for an influx of new clients who will now have access to insurance. The centers also predict existing patients will come on a more consistent basis, rather than just for emergencies or major illnesses, once they are insured.
"Our world is about to change," said Kevin Lindamood, CEO of Health Care for the Homeless, where 70 percent of the patients don't have health insurance.
State officials estimate that one-third of 750,000 uninsured Marylanders, including 25 percent of those treated by community health centers, will gain coverage under the Obama health initiative in its first year. Those living on less than 138 percent of the federally established poverty level — about $32,500 for a family of four — will gain coverage through an expansion of Medicaid that will bring low-income adults without children onto the insurance rolls.
Those who work for employers that don't offer insurance can buy coverage on a state exchange, or open marketplace, beginning in October. Individuals would have to pay a penalty to opt out.
The health centers don't know how many patients they will gain or how fast it will happen. Just who will buy on the exchange or enroll in the Medicaid program is unpredictable. Some people may choose to pay a penalty rather than sign up for coverage.
Many expect the biggest increase will initially come from the expansion of Medicaid. Individuals may have to be convinced it is worth it to pay for coverage, he said.
"Some people think they are invincible and won't get sick," said Richard L. Larison, CEO of Chase Brexton. "Others will worry about whether they can afford to pay for insurance, given their other expenses."
Chase Brexton logged nearly 157,000 visits in the 2012 fiscal year at its four locations in Baltimore, Randallstown, Columbia and Easton. About 68 percent of its patients are uninsured or on Medicaid or Medicare.
The clinics say outreach will be critical in reaching the vulnerable populations they serve. Studies have shown many Americans are unclear about the details of health reform and how it will benefit them.
"Although the bell rings on Jan. 1, that doesn't mean everybody will get signed up," said Jay Wolvovsky, president and CEO of Baltimore Medical System. "I think it will take a while to reach a lot of people who don't know what's going on." The system treats about 46,000 patients at six clinics and eight school-based programs. About 10,000 of those clients are uninsured.
Many of the clinics are beginning to prepare for an influx, despite the unpredictability. They are hiring primary care staff as well as workers that will go into communities to educate people about reform. The U.S. Department of Health and Human Services recently said it was giving $1.6 million in grants to 15 Maryland health centers to enroll the uninsured.
The centers are also expanding facilities. Chase Brexton will move into a new 90,000-square-foot facility this fall, and Baltimore Medical Care System will add 14,000 square feet of space to its building on the campus of Saint Agnes Hospital in Baltimore.
For health care providers like Annie Lee, a nurse practitioner at Chase Brexton, the expansion means seeing more patients — the clinics are preparing for the possibility of four times more. Lee said she sees as many as 16 patients a day, while doctors see more, and Chase Brexton is adding staff to accommodate the growth.
That's a good thing, clinic officials said, given their emphasis on building rapport with patients to help them manage their health even when they are feeling well.
"It shouldn't be an illness-based model," Lee said. "I think health care reform is going to help change that."
The changes also have the potential to alter the business model of health centers so that they have more resources. Lindamood said. Health centers survive now by stitching together grants. Reform will enable clinics to charge specific services through insurance.
"If we can actually bill for health care services, we can leverage more of our grant money and private dollars for efforts toward our commission, which is to end homelessness," Lindamood said.
Health centers will continue to have to treat some uninsured as part of their mission. People who are in the country illegally won't be able to enroll in insurance, for instance.
"They will still operate under the mission that they always have," said Bernadette Johnson, director of programming services and business development for the Mid Atlantic Association of Community Health Centers, which serves centers in Maryland and Delaware.
The association is working with health centers to get them up to speed on implementing health plan.
"Doctors and folks that have been involved all along know what's going on," Johnson said. "A lot of their staff haven't really wrapped their heads around what is going to happen, especially the frontline staff. These are the folks that have the first contact with patients."