A Thousand and One Champions 2012 Closing Remarks

by Therese Rodriguez
May 23, 2012

Rodriguez poses with A Thousand and One Champions 2012 Honoree Dr. Lisa Eng (far left)and Hon. Doris Ling-Cohan (center).

As we end this wonderful evening, we thank you for being here to mark a milestone in APICHA’s 22 years of existence. Tonight, the Asian and Pacific Islander Coalition on HIV/AIDS is formally called APICHA Community Health Center. We are now a community health center, but not yet a Federally Qualified Health Center (FQHC). Let me explain this riddle.

Community health centers started as a movement in the 1950s to serve the poor. At these centers, the poor were able to receive preventive and medical services rather than get their primary care needs met in emergency rooms. Federal designations began in the 1970s. To get a designation, a clinic must be serving particular geographic neighborhoods or any of the medically underserved populations: the homeless, agricultural migrant workers and residents of public housing.

By current rules APICHA Community Health Center does not quite fit.

Why is this so? In the course of doing HIV work, APICHA built a service delivery model with medical services at its core, surrounded by robust prevention and support services for people living with HIV/AIDS. In 2009, through a New York State capacity grant, we extended primary care services to individuals at risk for HIV. Many who came identified as lesbian, gay, or bisexual individuals, people of trans experience, immigrants and people from communities of color.

We serve those who feel unwelcome in mainstream health care facilities. We serve hard-to-reach folks who are stigmatized because of sexual orientation, gender identification, immigration status, and HIV status. They come to us for high-quality, culturally-competent and sensitive care. They come from every zip code of the city except for one gated community in the Bronx. We serve the whole city and beyond. For us the whole city is our neighborhood.

Our life began as an HIV/AIDS organization. As such, APICHA Community Health Center evolved and operated outside the FQHC system. But the Obama Administration changed all that. The Affordable Care Act and the National HIV/AIDS Strategy call for the integration of HIV care and care for marginalized populations into FQHCs. If this were the case, rules must be broadened to allow stand-alone clinics like APICHA Community Health Center into the FQHC system. Look, if you think about it, we look like a duck, talk like a duck, walk like a duck but we are not allowed to swim in the pond. It is imperative that we get resources to continue the services created specifically for the underserved populations who are attracted to us. Imagine how many more we can serve with an annual grant of up to $650,000, malpractice insurance coverage, enhanced Medicaid/Medicare reimbursement rates, and access to financial distress relief programs. Most recently, FQHCs in New York State received federal capital expansion grants of over $41 million authorized under the 2010 Affordable Care Act. Existing FQHCs received grants in the range of $500 grand to $5 million dollars each. Good God! That’s no small change! The grants are intended to build the state’s capacity to provide much needed primary care to 3 million residents who will have insurance coverage by 2014. Community health centers are expected to play a central role in meeting this dramatic rise in health care demand.

LGBTs and immigrants have been advocating for changes to the FQHC rules. The Health Resources and Services Administration (HRSA) had convened the Rules Committee with mandate from the Affordable Care Act to undertake the process and make recommendations to the Health Secretary on ways of directing resources to areas or populations showing the greatest needs. The Committee report recommends that immigrants and refugees, LGBT individuals, and people living with HIV be considered medically underserved. It also recommends that facilities with the expertise and provide culturally sensitive services to specific population groups be considered a special category. APICHA fits these recommendations, and these can open a pathway to the pond so to speak.

To make this happen, however, Secretary Kathleen Sebelius must muster the political will to recognize a new generation of community health centers like APICHA, to do what is right, to be forward thinking by recognizing existing safety net clinics that are also safe spaces for marginalized populations. APICHA is already that safety net and safe space.

In our short life as general primary care provider, APICHA Community Health Center has already gained recognition as a Level 3 patient-centered medical health home – the highest level attainable – from the National Committee on Quality Assurance. Moreover we continue to aspire to create an environment that is truly inclusive of individual identities. Consider our one-of-a-kind Trans Clinic, which we created last year to support a community that is one of the most neglected in the country.

We invite you to be part of APICHA’s monumental efforts to get federal designation so that our patients and thousands more will benefit from the APICHA’s brand of care.

In closing, I’d like to read a poem that I wrote for this occasion – just one of the things this CEO does when faced with challenges.

I climb like a vine
More like a goat
A vine climbs
Takes the shape of a trunk
Of any tree
A vine spreads itself
Climbing walls
Taking over erudite halls
Vines filling in urban iron fences
Covering stones
Making ground cover
Steady as a goat
Born a Capricorn
On January 2
Finding footing in rocky terrain
Gripping rocks
Contorted by crosswinds
Clinging to crevices
Planting both feet on the ground
Navigating shifting terrains
Over precipitous abyss
Climbing
Exhilarating
The earth farther and farther away
I must reach the mountain top
Meet the sun eye-to-eye
And from that breathtaking height
I take it all in
Looking down with the eyes of a monarch
Embracing humanity
Standing side by side with him

I entitled this poem “Good morning Dr. Martin Luther King, Jr.”

Finally, deepest respect and my sweetest congratulations to all staff, board members, all supporters, honorees. You made APICHA Community Health Center happen!

La lucha continua! The struggle continues! And, as I would say in pre-CEO days: Makibaka! Dare to struggle.

Thank you, good night and sweet dreams!