Hawaii’s 14 community health centers have seen a spike in clients in recent years as fewer private doctors accept Medicaid and Medicare patients because of low reimbursements and increasingly burdensome paperwork.

The nonprofit centers welcome the growth and see it as part of their mission to help those who can’t get help elsewhere.

The Medicaid population at community health centers soared 35 percent between 2009 and 2010 to 58,971.

"If no one else takes care of these Medicaid patients and they end up in the emergency rooms for care, that hurts all of us," said Matthew Nagato, spokesman for the Hawaii Primary Care Association, which represent health centers statewide. "It used to be what people called the safety net, but given the numbers of people served by health centers, it’s now really forming the backbone for primary care services, not just in Hawaii, but throughout the country. The need for these services is almost inexhaustible."

When patients use community health centers instead of emergency rooms, it saves money. Emergency rooms are seven times more costly than primary care, according to the Hawaii Primary Care Association.

But with some primary care physicians showing a preference for patients with private insurance over Medicaid or Medicare patients, the emergency room becomes the option of last resort.

That’s where community health centers come in.

They accept people covered by Medicare and Medicaid, which has been a growing pool of clients. There was a 26 percent boost in Medicaid enrollment from June 2008 through December 2010.

The centers also take those without insurance. Their numbers are likely to grow in 2012 once Medicaid cuts about 4,500 Hawaii residents from the government-funded program on Jan. 1.

"If those 4,500 people who are going to be kicked off Medicaid had problems finding a doctor to take them before, now that they’re going to be uninsured, they really have no where else to go but to a health center," Nagato said. "If community health centers find that they can’t take care of these new uninsured, they will end up in the emergency room."

The state will implement $150 million in Medicaid cuts over two years and decrease the Medicaid eligibility for adults to 133 percent from 200 percent of the federal poverty level, according to the Hawaii Department of Human Services. Most remaining on Medicaid will see services reduced next year as well.

"We’re going to see a tremendous amount of increase in patients once they have exhausted their limited benefits," said Adrianna O’Donnell, chief marketing and development officer at the Waikiki Health Center, which saw a 14 percent boost in the number of patients who received services in the first half of the year over the same period last year.

Community health centers, funded in part by federal and state governments, are required by law to serve all patients regardless of ability to pay, and get reimbursed at higher levels than private practitioners as a result of providing more services, including mental health, dental and nutrition.

Overall last year, the 14 centers, governed by community boards, served 125,442 patients — a 7 percent gain from the previous year, a 48 percent increase over five years and a 105 percent jump from more than a decade ago.

Increased demand forced the Waikiki clinic at 277 Ohua Ave. last year to enclose the end of a hallway to create a retinal screening room and convert a lanai into three additional exam rooms, O’Donnell said.

The Waikiki clinic saw 20 to 22 new patients daily last year, up from 10 to 12 the year before. It served 5,733 patients in 2010.

Kakaako resident Kim Gravelle, 70, who is covered by Medicare and Medicaid, said he goes to the Waikiki clinic every three months for his amyotrophic lateral sclerosis — or ALS, often referred to as Lou Gehrig’s disease — and would have no access to care if it weren’t for the health centers.

"I don’t work, obviously, so if I had to pay I wouldn’t be able to," he said.