A proposal for a Community Health Center in Powell got its first public airing during a meeting last week.

Community Health Centers are health care clinics that operate 40 hours per week to provide health care on a sliding-fee scale. They are funded with a combination of federal grants and money raised locally and are governed by local boards similar to the one that guides the Heart Mountain Volunteer Medical Clinic.

Jerry Schaefer of Powell, who serves on the board for the free clinic, said the need for low-cost medical care outstrips the clinic’s ability to provide it. The free clinic provides care to uninsured, low-income people who have household incomes of 200 percent of the federal poverty line or less. But it cannot provide care for people above that income limit. That is proving to be one of the greatest unmet needs, he and other clinic representatives said.

“There are a lot of people who are turned away because they make just a little too much money,” said Dr. Valerie Langfelder, who gives some of her time to provide care at the Heart Mountain Volunteer Medical Clinic.

Langfelder said working at the clinic is worthwhile, but stressful. The volunteer work is in addition to providers’ regular work in the Powell Valley Clinic and at the Powell Valley Hospital. Patients at the free clinic often have serious medical problems complicated by lack of care, and they may have insufficient information about their medical history, she said.

“It’s difficult, it’s demanding, it’s exhausting,” she said.

While nothing would prohibit the free clinic from functioning alongside a Community Health Center, both would need to raise funds locally, and it is unlikely that the Big Horn Basin community could support both, Schaefer said.

When asked why the Heart Mountain Volunteer Medical Clinic doesn’t provide medical care on a similar sliding-fee basis, clinic co-organizer Madelyn Morris said the clinic’s status as a 501c3 nonprofit organization prevents it from charging or billing patients.

It also would be impossible to see all those additional people on just two evenings per week — Tuesdays in Powell and Thursdays in Cody, she said.

“To expand, we need funds, and we need a bigger infrastructure,” she said.

Chuck Wiltraut, of CJW & Associates, a community and organizational development firm in Pennsylvania, gave much of last week’s presentation.

“A Community Health Center begins and ends with the community,” Wiltraut said. “It’s partnering, doing what you’re already doing.”

Pat Monahan, executive director of the Wyoming Primary Care Association, said this is a good time to start a Community Health Center.

“There’s a lot of opportunity, a lot of money available now,” he said. “We’re not sure how long it will be available. We’re thinking three to four years.”

But the idea of taking federal money to establish a Community Health Center in Powell and possibly displacing the free clinic rankled some in the audience.

One man said, “I’m wondering what strings get attached if we accept this federal money. It’s not coming from outer space. It’s coming out of my pocket.”

Wiltraut said the community board governs the clinic and makes decisions about the services it will provide, but it also must meet federal requirements, such as matching local funds and a checklist for specific services.

Wiltraut said there are 19 program requirements, and each center must report on those annually. Centers must reapply for their federal funding every three years.

“You will be held accountable,” he said.

One requirement is that at least 51 percent of the board also must be patients at the center, he said.

“They need to be able to report to the board about their experience: How long was it before I was roomed? How was I treated?”

Wiltraut said the Community Health Center system has “tremendous bipartisan support,” beginning with former President Bill Clinton in 1994, then continued through the Bush and Obama administrations. Federal money has been set aside for Community Health Clinics. If one is not built in Powell, that money will pay for a clinic somewhere else, he said.

“There’s going to be 49 states applying for these dollars,” he said. “Don’t we want some of it? If not, it will sure go to states like California and Florida.”

“We’ve heard that before,” the man retorted. “I don’t buy it.”

“That’s OK,” Wiltraut said. “I’m not selling ... Before we even make a commitment to move forward, let’s ask those kind of questions. You say, ‘I don’t trust it.’ Let’s find out why. I don’t want to force anything on you.”

Added another resident:

“Just because these other scum-bag states like California and Florida are taking this money, why does that make it good for Wyoming to do it? It’s like looting — ‘Look at all this free stuff I got. Shouldn’t we do that too?’”

Wiltraut replied, “Looting is stealing. That’s not what we’re doing. We’re providing health care, mental health care, dental health care.”

Dr. Larry Akin, a local dentist, said he attended because of the growing need for dental care for people on Medicare and Medicaid, as well as others with low incomes who have no dental insurance.

“Today, I read an article that stated three out of every five poor people are now elderly. Adult people on Medicaid really have a hard time getting dental care. I’m here to say the dental aspect is kind of an orphan child. Medicine is brought to the forefront. Me, speaking personally, I would love to help more of these people. That’s why I’m here.”

Wiltraut said one Community Health Center, even before it opened, had to schedule dental appointments for three to four months ahead.

“That’s how big the demand was,” he said.

One person asked if the center would compete with the hospital and local medical providers.

Wiltraut said Community Health Centers complement existing services by helping meet medical needs that would go unmet otherwise. The centers provide care for people of all incomes and circumstances, so some people formerly treated at the local clinic also would obtain care there. But, since demand for medical care in the Basin exceeds services to provide it, that shouldn’t be a problem.

He added that the center also would rely on services from Powell Valley Hospital.

“The government won’t give you money unless you play nice-nice with the local hospital,” he said.

One person in the audience referred to the Community Health Center in Riverton that closed earlier this year. They asked what went wrong, and if that was likely to happen in Powell.

Wiltraut said the Riverton center’s problems were the result of a poorly-functioning board. He noted that clinic will open again soon, with a Casper board serving as an interim grantee. (See related story)

“Riverton... didn’t have people raising questions or concerns,” Wiltraut said. “Their board of directors was not fully engaged. They did not ask the executive director about the cash flow sheet. They did not have the skill set to ask for help. When they did, it was too late.

“If a board were to form here, I think you would have a good one. You’ve already got a good one.”

Wiltraut urged residents to study the issue, decide what they were comfortable with, and let someone know how they feel about the issue.

JoAnn Cozzens, executive director of the Heart Mountain Volunteer Clinic, said people are welcome to contact her with feedback.

She can be reached at jacozzens@hmvmc.org or by calling 754-1142.