In 2021 and 2022, reporters Kim Krisberg and David Leffler made six trips to rural Henderson County, Texas, to interview two physicians who had opened a clinic for low-income, uninsured residents. The initiative underscored a larger issue: Because state leaders had refused to expand Medicaid, more than a million Texans, many of whom lived in rural communities, were struggling to get health care. 

What follows is an update on the doctors’ efforts to make the East Texas Community Clinic a federally qualified health center — an official designation that is key to the clinic’s long-term survival. Read the original story here

It was one of the most rigorous inspections Glen Robison had ever been through — more grueling, even, than the ones he’d experienced in the Air Force. 

“It was intense,” said Robison, chief executive officer at the East Texas Community Clinic, which opened in rural Henderson County in 2020 to care for the area’s many poor and uninsured residents.

Over three days earlier this month, the clinic’s leaders met with a team of inspectors from the U.S. Health Resources and Services Administration for a virtual site visit. The inspection was a crucial step toward becoming a federally qualified health center, or FQHC. The designation is given to clinics caring for medically underserved populations and makes them eligible for enhanced payments and millions of dollars in federal grants. 

An ongoing series on the 11 states that refuse to expand Medicaid. Read other project stories.

The meeting with the HRSA inspectors was very good news. Robison had spent thousands of hours learning how to navigate the FQHC process and assembling the clinic’s application. In fact, he’d applied twice, having had his first attempt rejected. A site visit meant the clinic was closer than ever to winning the status it’s been seeking for more than two years.

The clinic relies heavily on donations from local foundations to stay afloat, but that won’t sustain it in the long term. Securing FQHC status is essential to its stability. “Seven thousand people depend on us,” Robison said, referring to the clinic’s patients.

In September, Public Health Watch published a narrative about Robison and the two physicians and longtime friends — Doug Curran and Ted Mettetal — who founded the clinic. Its two locations, in Gun Barrel City and Athens, accept anyone who needs care, regardless of their ability to pay. 

Ted Mettetal, left, co-founder of the East Texas Community Clinic, and Glen Robison, its CEO, in the clinic’s new Gun Barrel City building, which it moved into last summer. Credit: Kim Krisberg

Their story underscored Texas’ high uninsured rate — the worst in the nation at 18% — and state lawmakers’ continued refusal to expand Medicaid, as 39 other states have done. The Houston-based Episcopal Health Foundation estimates that more than 1.2 million Texans could gain health coverage if lawmakers changed their minds on expansion. 

In the months after the East Texas Community Clinic opened its first location in a renovated accounting office off Main Street in Gun Barrel City — where nearly 33% of residents younger than 65 are uninsured — thousands came in for care. 

Today, according to Robison, 30% of the clinic’s patients are uninsured and 40% have Texas Medicaid coverage, which reimburses at much lower rates than private insurance. With FQHC status, the clinic could receive higher payments for treating Medicaid and Medicare patients and be less reliant on donations to keep the doors open and see more patients.

Since 2020, the clinic’s patient load has grown from about 1,500 to more than 7,000. So far, Robison, Curran and Mettetal have been able to raise enough money to meet the growing demand, but this isn’t a substitute for an FQHC designation. The clinic has often had to survive month-to-month. 

Just before Public Health Watch published its story in September, Robison had received the email he’d been waiting for: HRSA was ready to schedule a site visit regarding the clinic’s FQHC application. His second attempt at applying had worked. But the suggested visit date wasn’t until March 2023, which would have meant extra months of financial strain.

After the Public Health Watch story caught the attention of lawmakers in Congress, HRSA pushed up the visit to mid-December.

The virtual visit commenced Dec. 14 and ended Dec. 16. Robison immersed himself in prepping. “When something challenges me, I just dig my heels in,” he said. He and the doctors knew the inspection would be exacting, and it was.

“It was so much harder than I ever dreamed it would be,” said Curran, who’s practiced medicine in Henderson County for more than 40 years.

Inspectors found a handful of deficiencies, Robison reported. All are related to administrative and governance issues, such as the format of the clinic’s board minutes; none had to do with patient care. Once Robison receives HRSA’s official inspection report, probably in January, the clinic will have about a month and half to address the problems. 

Robison has already started making the fixes. “Of course, my goal was zero findings, but you know it won’t be perfect,” he said. “All the issues are correctable.”

When Robison, Curran and Mettetal opened the East Texas Community Clinic in May 2020, they thought they’d have FQHC status — and access to the federal dollars that go with it — by late 2021. Now it looks to happen no sooner than spring 2023. 

For now, the clinic has enough financial support from private donors and the state to get through the next few months. It’s finally begun receiving funds from an FQHC incubator program that Gov. Greg Abbott signed into law more than a year ago. 

“But we still have to proceed with caution,” Robison said. “You never know what’s ahead.” 

On Dec. 16, the clinic’s staff and supporters gathered for their annual Christmas party. Nearly 100 people came to celebrate — almost four times the number who showed up for the first holiday gathering in 2020.

Robison showed a video he’d made of the clinic’s history, patching together more than 600 photos. Mettetal read the Christmas story from his grandmother’s Bible. He sat in a rocking chair he brought from Curran’s porch — the same one he sits in before he and Curran go on their ritual morning walks. It was during one of these walks that the friends came up with the idea of starting the East Texas Community Clinic. 

“There’s an enormous need we’re filling,” Curran said. “Now we just need the funding to sustain ourselves.”

This story is part of “The Holdouts,” a reporting collaborative focused on the 11 states that have yet to expand Medicaid, which the Affordable Care Act authorized in 2010. The collaborative is a project of Public Health Watch