Everyone can get primary care, mental health care and dental care at Northwest Human Services, regardless of what insurance they have or their ability to pay. That meant that when news broke that thousands of Medicaid patients in Salem would soon need a new place to get health care in Salem, the question wasn’t whether the primary care provider would accept them. The question was how they’d help as many people as possible.  Northwest Human Services will be taking on 2,500 additional Medicaid patients who will lose their coverage at Salem Clinic starting Jan. 1. It’s a situation CEO Kimberly Leathley said allowed their team to serve its purpose as a safety net for low-income people in the community, while underscoring the need for a more stable Medicaid system. Salem Clinic will continue to see Medicaid patients for obstetrics and gynecology, but could not reach a contract for around 10,000 patients to receive primary care, urgent care and endocrinology with PacificSource, the not-for-profit insurance company that administers the Oregon Health Plan in a number of Oregon counties, including Marion and Polk. Leathley said other providers in the community are also working to take on more Medicaid patients as a result. Northwest Human Services is one of two federally qualified health care centers in town, along with Yakima Valley Farm Workers Clinic. That means they’re required to serve everyone. In exchange, Leathley said that status comes with a different, more stable, payment model with money from a separate federal program and a different Medicaid payment model than other primary care providers.The majority of Northwest Human Services’ 15,000 patients – 65% – are on Medicaid. The rest are dual enrolled with Medicare, use commercial insurance, or are uninsured. The organization also help patients apply to Medicaid, and aims to get people engaged and returning for follow-up appointments and check-ups. “If people come without insurance, it’s OK, we have a sliding fee scale that they can pay relative to their income,” Leathley said. “We serve anyone, any way, at any time. And that is a special responsibility, and it comes, also, with the privilege of being designed to serve this population.” Northwest Human Services has primary care for infants through seniors at its West Salem clinic, which also has dental screenings and mental health care. Twice a week, providers from that clinic head downtown to the Homeless Outreach and Advocacy Project to offer free medical exams. Some of their regular patients were first contacted through the organization’s street outreach team which includes nurses.  The calls from anxious patients started coming in this summer, when rumors began circling that Salem Clinic would no longer be able to take Medicaid, said Melissa McCartney, director of patient access. “There was a lot of concern about: ‘Where am I going to go?’ Because they know that there is limited availability in the community for family practice medicine,” she said.Many had questions about how to get a new doctor and how to ensure they would get their regular medications refilled on time. The team evaluated how to create more capacity, and ultimately decided to hire a new physician specializing in family medicine to support the expansion, said Clinic Director Koua Cha. The patient access team, nursing and clinical teams also sat down to evaluate current workflows, making changes to intake processes. They arranged a nursing team to focus on onboarding 500 new patients per month, starting with the highest acuity patients such as people with necessary medications or those who were pregnant. “The front desk, the outreach team, the nurses, primary care team, everyone knows that this is coming, so they’re prepared, just mentally. And also knows that anyone who walks in the door will not be turned away. So communication is a key part of the change,” Cha said. Leathley said that the team’s response, beyond being their duty as a federally qualified provider, came from a collective belief that everyone deserves health care. They also give people an option outside of the emergency room, or waiting so long to get primary care that it becomes an issue needing hospitalization, helping free up other parts of the health care system. “Northwest Human Services is financially stable, and we are keeping our programs open and our access wide, and we’re growing,” Leathley said. “We’re leaning into growth during a time that there’s potential disruption in the Medicaid space, either from the shortfalls in the Oregon budget and/or the changes in the Trump administration.”Leathley said that the Trump administration’s Medicaid policy changes which will take effect next year mean they’ll be seeing more patients who can’t afford health insurance, need gender affirming care or who will be ineligible for Medicaid due to higher barriers such as work requirements. “There are significant threats coming. When the administration’s policies come into effect, there are people in this community that are going to be harmed,” Leathley said. “Are we still going to be there for them? Absolutely.”Beyond the influx of patients from Salem Clinic, hundreds more could be on the way. There’s uncertainty about the status of PacificSource contracts throughout the community. That includes Salem Health, the largest provider in the region, which has not yet reached a deal to provide care for Medicaid patients in the coming year.  “We’re standing ready to come to the table with PacificSource, with our community partners, to figure out how we can help,” Leathley said.   Northwest Human Services also hasn’t reached a contract with PacificSource for the year, but she considers them a key partner in the community.“We are in conversations with the community and really encouraging PacificSource to stabilize the funding to providers like us, but it’s a real conversation about how Medicaid gets funded by Oregon. And of course, the governor has convened a table of very, very smart people to help grapple with the issues of Medicaid funding,” Leathley said.Leathley said it’s their job to welcome everyone into their clinic, while continuing to face the challenges as they come.  Dr. Eric Chen is among the providers who works at both the West Salem clinic and the downtown clinic serving homeless people in downtown Salem. He said that the policy issues spotlight the challenges people in poverty face every day. “We interact with the poorest, the most marginalized and fragile in our community every single day,” he said. “We would like this to call attention to what is happening, so that it is on the forefront of people’s attention, so that they can ask themselves: ‘Is this right?’ ‘Is this how it was supposed to be?’ And if more people ask themselves that question, maybe we can start to see some change on a larger scale.” Contact reporter Abbey McDonald: [email protected] or 503-575-1251. 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