Prince George’s task force hears shortfalls in HealthAssure program and cost pressures on FQHCs

Prince George's Cares Healthcare Task Force members heard a review of the county's HealthAssure program Tuesday and testimony from six federally qualified health centers (FQHCs) on how limited funding is leaving many visits unreimbursed and clinics absorbing significant costs.

The presentation by Prince George's County Health Officer Dr. Matt Levy and remarks from Sharon Zlewski of the Regional Primary Care Coalition and multiple FQHC leaders detailed program history, eligibility, recent budgets and utilization, and recommended follow-up steps for the work group.

The HealthAssure program, started in 2018 to help uninsured residents (those ineligible for other government assistance and living at or below 200% of the federal poverty level), grew from an initial county allocation of roughly $117,000 to larger infusions from COVID- and ARPA-related funding. Dr. Levy said FY 2024 funding was $5 million and FY 2025 funding is approximately $5.2 million, and he warned that those dollars "run out at the end of this fiscal year." He described HealthAssure as a reimbursement model in which the money is paid to FQHCs for covered visits and does not "follow the resident."

Why it matters

The task force was shown two intersecting funding gaps: the difference between HealthAssure reimbursement levels and actual FQHC operating costs, and the program's historical tendency to exhaust its annual allocation partway through the fiscal year, leaving months of care uncompensated.

Zlewski said the HealthAssure reimbursement rates understate the actual cost of services. "The average cost for primary medical care for the Prince George's County Health Centers providing care to all of their patients is $287 per visit," she told the group, adding that preventive dental averaged about $320 per visit and behavioral health about $287 per visit. FQHC speakers gave similar figures: Greater Baden Medical Services reported an average primary care cost near $344 per visit and behavioral health around $275.

Key figures and utilization

- Reimbursed visit counts reported by the health department: roughly 29,000 visits in 2022; about 45,000 in 2023; ~30,700 reimbursable encounters in 2024 though the program ran out of funds before paying about 3,260 of those; and 23,931 reimbursed so far in 2025 with additional funds pending. Dr. Levy cautioned that some year-to-year comparisons are deceptive because of one-time COVID dollars and partial-year reporting.

- Zlewski told the task force that FQHCs estimated nearly $4.0 million in encounters provided March'June 2023 went unpaid when funds ran out, and that unpaid encounters rose to roughly $4.5 million for February'June 2024.

- Greater Baden reported it served about 15,000 patients in Prince George's County in 2023; CCI said it served 18,416 Prince Georgians last calendar year and had an overall patient census above 40,000; La Clinica del Pueblo reported 2,711 unique Prince George's patients and roughly 9,000 clinical appointments in 2024. FQHCs said the percentage uninsured varies by site (some sites with 30% uninsured, others 60%+).

Eligibility, billing and administration

Task force members asked how HealthAssure eligibility and billing are handled. Dr. Levy and FQHC presenters said eligibility criteria are: uninsured; ineligible for other government insurance; and household income at or below 200% of the federal poverty level. Presenters emphasized that HealthAssure is not an enrollment-based health plan: FQHCs submit claims for visits that meet the criteria, the county reimburses up to the program's available budget, and the money is paid to providers rather than as an individual benefit card for patients.

Administration and data gaps

Health department staff and Zlewski recommended stronger program administration and better data collection. Dr. Levy said the current program functions as a reimbursement-only model and lacks an administrative infrastructure for tracking visits, claims detail (new vs. follow-up visits), outcome measures, and provider/patient-level enrollment that would be needed for more advanced measurement of health outcomes. Zlewski and FQHC leaders said some data exist at the centers but that county reporting stopped accepting claims after funds were exhausted, complicating historical accounting.

Funding outlook and policy follow-up

Multiple speakers warned the group that FY 2026 county budget materials then available did not include a dedicated HealthAssure appropriation and that federal policy changes (including possible changes to FMAP and other Medicaid funding streams) could increase the number of uninsured residents. Dr. Levy said he would try to provide a clearer fiscal forecast at the next meeting, and one councilmember reported drafting legislation to create a direct county funding stream to the health department (a dedicated pipeline or surcharge) that could sustain HealthAssure if annual appropriations fall short.

Task force next steps

The group set a plan for follow-up: participants were asked to review the materials and send written follow-up questions to Sandra Eubanks so staff could compile them for FQHCs, county health department staff and other partners to answer before the next meeting. The task force scheduled the next meeting for March (time listed in the meeting: "March at 01:30"). Task force staff also said they would coordinate with hospitals and other partners for the subsequent session.

Voices from the meeting

- Dr. Matt Levy, Prince George's County Health Officer: described the program history, current budget levels and the program's reimbursement-only structure.

- Sharon Zlewski, Executive Director, Regional Primary Care Coalition: "The average cost for primary medical care for the Prince George's County Health Centers providing care to all of their patients is $287 per visit." She stressed that HealthAssure reimbursements do not cover the full operating costs of FQHCs.

- Chris (Greater Baden Medical Services representative): described his center's payer mix and said the center's cost per primary care visit is substantially above HealthAssure reimbursement.

- Dr. Rich Schoesker, Interim CEO, Mary Center: urged continued county support and highlighted the risk to patients if federal Medicaid funding changes.

- CCI representative (name not specified in transcript): gave an overview of CCI's Prince George's volume (18,416 Prince Georgians served last year) and staffing footprint.

What the record shows and limits of coverage

This article summarizes remarks presented at the task force meeting and cites funding levels, visit counts and per-visit cost figures discussed by county health staff and FQHC representatives. No formal motions or votes were recorded at this meeting. Several numbers reported by presenters came from FQHC internal calculations or HRSA UDS data cited in presentations; where the transcript indicated disagreement or differing source counts (for example, slight differences in billed vs. paid encounters), the article reports that discrepancy rather than selecting one figure as definitive.

Next public meeting and follow-up

The task force asked participants to submit written questions to Sandra Eubanks before the next meeting so centers and health department staff can prepare more-detailed follow-up information. The task force's next meeting time was announced as March at 01:30 (staff to confirm exact date and whether the session will be virtual or in person).