Community health centers and organizations that primarily serve low-income people are being disproportionately hurt by the biggest hack in health care history, which has disrupted payments for thousands of health care providers for a month now.

The hack, which crippled Change Healthcare, the clearinghouse for 30% of medical claims in the United States, has forced providers to find alternative funding sources to stay afloat. For large providers, like many health care systems, that comes in the form of reserves set aside for emergencies.

But for smaller providers, like many community health centers, that can mean taking out lines of credit, which can come with large interest rates, missing payments to vendors and seeking a hodgepodge of support from insurers that are willing to front payments.

“It’s been very tough for us,” said Robert Hilliard Jr., chief executive officer of Legacy Community Health, based in Houston.

Legacy, which has 57 clinics across Texas, processes about half of its claims through Change Healthcare. It currently has about eight figures in unpaid claims waiting to be processed, he said.

“We’ve had to extend a line of credit with a bank because we’ve had no funds” and negotiate with vendors on missed payments, Hilliard said.

The debate surrounding the Change Healthcare hack has largely been dominated by the impact on large health care systems, which move billions of dollars a day in claims. Americans spent $1.4 trillion on hospital care in 2022.

But in many cases, hospitals have more resources to weather emergencies like this. An analysis by KFF of 274 nonprofit hospitals and health systems found an average of 218 days’ cash on hand.

Fewer resources

But that’s not the case for many community health centers, which primarily see Medicaid patients, rely on grants and have thin operating margins. The national average of cash on hand for health centers in 2016 was 64 days, according to the latest data available.

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