When Ebony Bascomb’s husband was diagnosed with colon cancer in September, she had to take a three-month leave of absence and cut back on her hours at the fast food restaurant where she is an assistant manager, to care for her husband and their five children.

“It felt like I was about to lose my husband,” said Bascomb, who is 36 and lives in Dearborn Heights. He’s doing better now, she said, but Bascomb still worries about maintaining a virus-free environment for him and her family. Throughout, Bascomb said, family members have stepped up to help.

So has their local health care clinic. Western Wayne Family Health Centers, where the family of seven has been going for about a decade, helped them navigate the traumatic situation.

The Inkster clinic helped Bascomb and her family connect with agencies to see whether they could help with rent and utility bills, made sure her husband had his medical supplies and that her kids’ prescriptions were filled, and helped her navigate insurance.

“We felt safe,” Bascomb said of the clinic, which serves people with insurance and charges fees based on income to people without insurance.

Free and affordable health clinics are, in normal times, crucial for people who can’t afford care or are uninsured. Now, during a health crisis, some clinics face financial challenges even as their role has expanded, with clinics offering wraparound services like food assistance and mental health care, to help patients across metro Detroit who have lost their jobs and are reeling from the economic blow of the pandemic.

Health clinics adjust

Community health centers are “the nation’s health care safety net,” said Tom Kochheiser, director of member services for the Michigan Primary Care Association, which includes 45 clinics across the state. They aim to provide care to people who live in medically underserved areas.

The CHASS Center in southwest Detroit is one of those places, where 95% of the clinic’s patients live at or under the federal poverty line, said Dr. Felix Valbuena, CEO of the center, which has been around for about five decades. The majority of the clinic’s patients prefer speaking Spanish and the staff is mostly bilingual.

The community that the clinic serves has been hit with pandemic job losses, Valbuena said. People are having trouble putting food on the table.

“There’s at least a 5% increase in our Medicaid volume since the pandemic started. And we can attribute some of that to the fact that individuals lost their job,” he said.

Although the clinic has seen a decrease in in-person visits and had to reduce capacity to curb the spread of the virus, it has remained open throughout the pandemic and increased telemedicine services.

The CHASS Center is a Federally Qualified Health Center (FQHC), meaning it provides services on a sliding scale based on patients’ ability to pay. There are more than 1,400 such organizations across the country, according to the National Association of Community Health Centers.

Among the approximately 28 million patients federally qualified health centers serve across the country, 91% have incomes that are at or below 200% of the federal poverty level, and 63% are racial or ethnic minorities, according to the Kaiser Family Foundation. Earlier in the pandemic, health centers had to adjust to stay-at-home COVID-19 orders, saw drops in patient visits for nonessential health care and faced workforce challenges, like temporary site closures and staff reductions, KFF found.

Health centers were some of the quickest to adapt to changing circumstances during the early days of the pandemic, said Phillip Bergquist, health center operations officer at the Michigan Primary Care Association. Still, “with all of the operational struggles, the workforce challenges on top of it, many of them are in a difficult financial spot because of all the revenue that they lost when services were postponed,” he said.

Federal support helped keep CHASS open. It received more than $1 million in federal COVID-19 aid, which allowed the center to give employees hazard pay and open a makeshift day care for staff when schools went virtual, Valbuena said.

“We work hard in high-need areas, whether it’s urban or rural, to make sure that we’re providing not just medical care, but comprehensive health and wellness services,” he said about community health centers like CHASS. “I think we’re a model of primary care for the nation.”

On the west side of Detroit, HUDA Clinic—which offers free services—saw a 22% drop in donations, a key source of funding. The clinic reduced hours and the number of volunteers who would normally help out, said Ghufraan Akram, who is on the board of directors for HUDA Clinic.

Still, HUDA didn’t have to shut down altogether because of a push for online donations, including a virtual fundraiser. A new partnership with Michigan State University and a residency program at Ascension Providence is bringing more volunteer physicians and medical students and could help reduce patient waitlists, allowing HUDA to serve about 20 to 25 more patients on what HUDA calls clinic days, when it hosts the expanded medical team.

There are four clinic days planned for next year, but HUDA wants to increase that to once a month through this partnership, Akram said.

“If we were closed for one or two months, where do our patients go?” he said. “… At a time like this, when folks have no jobs—even folks who had insurance might have trouble finding care—getting HUDA Clinic to stay open is even more paramount now, because this is a population that’s very vulnerable.”

Food insecurity, mental health needs heightened

Several health clinics see fewer patients in person during the pandemic, but bolstered their telemedicine services. Lisa Rutledge, special projects manager for Western Wayne Family Health Centers said “telehealth is here to stay” because it can remove the barrier of transportation.

Western Wayne has also been distributing about 100 boxes of food a month as part of a partnership with Gleaners Community Food Bank and has started a “take what you need” table in the lobby as well. They requested double the number of food boxes from Gleaners in December during the holidays, she said.

“We have community health workers who can help people navigate things like food assistance or utility assistance so they can help people with other challenges they might be having or refer them to a place that can help. We try to be holistic in taking care of people,” she said.

Overall, social determinants of health, like food insecurity and unemployment, were heightened by the pandemic, said Joslyn Pettway, CEO of Covenant Community Care. The pandemic also spurred an increase in behavioral health needs for managing anxiety and stress.

“Our social environment has a huge impact on our health outcomes and I think that was just exacerbated by COVID-19,” she said.

The faith-based nonprofit, which has five locations across metro Detroit, has also seen an increase in people coming in who have lost employer-sponsored health care and expects those numbers to go up next year, Pettway said. The clinic has been helping people navigate the health insurance system to become insured again, and has expanded its own food program to give out 250 boxes each month to families in need.

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