The building at 16th and Shotwell streets was last painted 25 years ago. Inside, the bathroom tiles are cracked and discolored. Every few months one of the ancient, hulking air conditioners breaks. The roof leaks.

This is Mission Neighborhood Health Center, and it needs a lot of work. All together, repairs for this essential medical facility are estimated to cost $1.1 million. And to the administrators here, that makes it a prime candidate to receive stimulus funding from a $2 billion pot earmarked for precisely such use.

But there’s a problem. The administrators don’t know how to access the money. They are not alone.

Across the country, many of the nation’s dilapidated community health centers say the funds they need have been set aside, but the federal government has yet to issue guidelines on how the money will be disbursed.

“I’m waiting for those processes to be put in place,” said Brenda Storey, Mission Neighborhood’s executive director.

Like many nonprofits that provide social services, the nation’s roughly 1,200 community health centers are straining to keep up with the human toll of an anemic economy.

Federal law requires these nonprofits to provide primary care to patients regardless of their ability to pay. In return, the government helps defray the cost with annual operating grants.

But those grants have failed to keep up with the rising demand for low-cost medical services. As more Americans have lost their jobs and employer-sponsored health care, the lines outside community health centers have grown. Many facilities, like Mission Neighborhood, are struggling to stay in the black.

Those realities have forced many to forego maintenance—or, worse, decide between making essential repairs and providing care. Nationwide, an estimated $4.4 billion in capital projects awaits financing at these facilities.

The federal stimulus promises a palliative in the form of one-time grants for renovations, construction, health information technology, and general operations. Other stimulus grants could help hire more staff.

On the ground in San Francisco, there’s just uncertainty about what the stimulus means.

“The question is, ‘What is a shovel-ready project?’” said Richard Hodgson, vice president of policy and planning for the San Francisco Community Clinic Consortium, a local alliance that is helping Mission Neighborhood Health Center organize its wish list for the federal government.

Under the law, the U.S. Health Resources and Services Administration has until mid May to figure out how to spend $1.5 billion on infrastructure projects, and an additional $500 million in general grants.

“At this point, all I can really say is that people here at the department are working hard to get the plans outlined,” said David Bowman, a spokesperson for the government. He added that money would likely be distributed through channels that already exist.

On Tuesday, President Obama announced that $155 million of the $2 billion would be used to establish 126 new health centers across the country. Details about how the remaining money will be allocated have yet to be announced.

But for Hodgson, the details are everything. How the government defines “capital projects” versus “renovations,” or prioritizes different kinds of health information technology, could all have a bearing on which projects get funded, he said.

For her part, Storey has her eye on renovations because they could be completed quickly. If she had money to knock out a wall in one of the labs, she could have two technicians at a time drawing blood, rather than one.

Electronic medical records would be nice as well.

She cautioned, however, that these kinds of projects missed the immediate need. During the past few months, Mission Neighborhood has seen demand for its services increase by 10 percent. The health center is so cash strapped that it stopped accepting new patients into its adult clinic in January.

“What community health centers need right now especially is more funding for operations,” said Storey.

Stephanie Berry, associate director for federal affairs at the California Primary Care Association, a health center advocacy group, agreed. “The real problem is that there’s just been such a spike in the uninsured,” she said. “A lot of those people are turning to health centers.”

That, paired with a tight credit market, is keeping them from investing in infrastructure, she added.

But Berry was confident that both operating and infrastructure grants would make their way to California. The state has roughly 10 percent of the nation’s health centers and the largest number of uninsured.

When her organization put out a request for shovel-ready projects last month, it received $100 million in proposals within a week. Mission Neighborhood’s was among them.

With that much demand, the delay can be frustrating. Still, health center advocates point out that the scale of the program presents its own challenges.

The federal government’s annual budget for these facilities is about $2 billion, said John Sawyer, director of federal affairs for the National Association of Community Health Centers, an advocacy group. The money set aside in the federal stimulus effectively doubles that sum, though it will be spent over two years.

“It’s a historic investment,” he said, adding that “it lives up to the legacy of the War on Poverty,” the 1960s social works program that was responsible for establishing the nation’s first community health centers.

Sawyer said his organization was trying to help the federal government spend the money quickly and effectively. Done right, he added, the program could create jobs in the economically depressed communities where health centers are located.

Sawyer also noted that the funds could be used to expand access to health care at a time when more Americans are losing insurance. This would lower health care costs in the long run because it would decrease visits to the emergency room for noncritical problems, he said.

“One of the consequences of having an uninsured population is that it puts a burden on the ER,” he added.

Helen Levy, a professor at the University of Michigan’s Institute for Social Research, was skeptical that the investment in health centers could deliver all the upside outlined by advocates.

“Of course some of it’s going to be spent on valuable things and some of it’s not,” she said. “I think it’s very hard to say—without knowing exactly what they’re going to do with it—that this money will help to improve the health of the population.”

Back in San Francisco’s Mission District, Brenda Storey had a pretty solid idea where the money could do some good. The forecast was for rain. Reflecting on the health center’s roof, she said, “You can plug it in with tar, but eventually you’re going to have to replace it.”

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Noah Buhayar is print and multimedia student at the UC Berkeley Graduate School of Journalism. He reports primarily on business topics. His work has appeared in the Financial Times, The Wall Street Journal, CBS’s business site and MarketWatch. Before coming to the Bay Area, he taught a semester of high school Spanish in Hawaii, spent a year in southern Chile on a Fulbright grant, and interned with the NewsHour with Jim Lehrer’s online division.

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