Community health centers are bracing for a tough year and calling for more state help, as the economic downturn drives more uninsured to their doors.

Last year, health centers on O'ahu saw a 10 percent increase in uninsured patients, and that doesn't include those who came in without insurance and were subsequently enrolled in Medicaid or the state's Quest program. The increase follows a steady rise in the number of uninsured seeking help from community health centers over the past five years, according to recently released Hawaii Primary Care Association figures.

From 2004 to 2008, health centers saw a 23 percent increase in the number of uninsured served.

The figures are spurring health centers statewide to raise concerns about their ability to serve new patients, especially with no new funding.

"We're the ones who are there for people who don't have medical care," said Waikiki Health Center executive director Sheila Beckham, adding that her center gets about six to 10 new patients a day, many of whom have lost jobs and are uninsured. That compares with just two to three new patients a day in previous years.

"Everybody is just getting slammed," Beckham said.

The 14 community health centers statewide get about $6 million annually from the state, plus some additional funding for outreach workers to enroll eligible residents in Medicaid or Quest and more money in the way of contracts for services. Proposed state House and Lingle administration budgets would keep funding for health centers about the same in the coming fiscal year, but would cut some of the funds the centers get through contracts. The House budget also proposes cutting several outreach workers.

CAP ON FUNDING

Meanwhile, the state has said that it would likely fund the health centers through cigarette tax money, rather than general funds as in the past. The development is a disappointment for health center operators, who had thought they would get all or a portion of the cigarette tax money on top of their annual state appropriation. The cigarette tax money was to go to needed capital improvements and to expand community programs.

The state also wants to cap the tax money to health centers at about $6 million, about $2 million less than the cigarette tax is expected to bring in. Health centers say they understand that times are tough, and so aren't asking for more in the way of state appropriations. But they are asking for the cap to be lifted.

Elizabeth Giesting, chief executive officer of the Hawai'i Primary Care Association, which represents community health centers statewide, said the centers need more funding to meet increased needs.

In the current funding proposals, she said, "there is no room for growth at all."

Giesting said health centers statewide are seeing more uninsured. Maui and Molo- ka'i, she said, have been particularly hit hard because of a spate of layoffs, and urban Honolulu is also seeing more people with no insurance.

"They're serving people who are not likely to get care elsewhere," she said, adding that for some the only alternative for care is an emergency room, where treatment is much more expensive.

Community health centers provide medical, dental and mental health services to underserved populations, including the uninsured, under-insured, low-income people, immigrants, the elderly, those who live in rural areas and the homeless. There are some 1,200 such nonprofit community health centers nationally.

GREATER NEED

Statewide, about 117,200 people visited community health centers in 2008 — up 42 percent from 82,600 in 2004. The growth is thanks to three new health centers opening over the period, more people seeking out medical help and expanded programs, including for dental care, health center officials say.

At Kalihi-Palama Health Center yesterday, the waiting room was bustling — as it is a lot these days. About 20 people were waiting to see a doctor. A dozen more were in a separate area, waiting for a dentist.

Faustino Molina, 43, walk- ed into the center yesterday seeking help after losing his job — and his insurance — in January. He said the cargo company he worked for as a driver went out of business. He is looking for a new job, but hasn't had much luck and needs medical care for his leg.

Molina walks with a cane after a car accident last May left him with a badly broken leg.

He said he is grateful to be getting medical care, even as he looks for a new job.

"I really need the help," Molina said, through an interpreter.

Emmanuel Kintu, Kalihi-Palama Health Center executive director, said the center saw a 21 percent increase in the number of uninsured people it served in 2008, compared with the year before. He said many of the uninsured had recently lost their jobs or seen big cuts to their work hours.

Annually, the center sees about 16,800 patients, not counting those who get dental care.

Kintu said the tough economic times are forcing the center and others statewide to consider some difficult choices to stay afloat. Those could include turning patients away, he said, or laying off workers.

"We are planning for the worst," he said.