Community Health Centers

Community Health Centers
Frequently Asked Questions – March 2014
Key Takeaways
What are community health centers (CHCs)?
CHCs are community-based and patient-directed organizations that serve
populations with limited access to health care.
When were CHCs established?
The Office of Economic Opportunity established “neighborhood health centers”
as part of the War on Poverty demonstration program in 1965. The “Health
Center Consolidation Act of 1996” enacted section 330 of the Public Health
Service Act, which packaged together health center funding into one dedicated
stream.
 In 2011, 1,128 health centers operating
8,500 sites provided 80 million visits to
20 million patients.
 CHC capacity is projected to double by
2019 - to 40 million patients.
 More than 40% of CHC patients are
covered by Medicaid.
 In states that have expanded their
Medicaid program, 42.6% of their
patients are covered by Medicaid.
What services do they provide?
Most health centers provide primary care that covers physical, oral, and mental healthcare. They also provide services that
help patients access care such as transportation and translation assistance. Between 2000 and 2011, the availability of both oral
and mental health care in health centers grew dramatically, a reflection of both widespread need and increased federal funding.
Health Centers at a Glance1
2009
2011
Percent Growth
Patient Population
Health Centers
Service Sites
Total Patient Visits
Medical Visits
Dental Visits
Mental Health or Substance Abuse
Visits
18.7 million
1,131
7,682
74 million
54.5 million
8.4 million
4.7 million
20.2 million
1,128
8,500
80 million
57.8 million
10.0 million
5.7 million
8.0%
-0.3%
10.6%
8.1%
6.1%
19.0%
21.3%
Other Professional Service Visits
6.1 million
6.1 million
0.0%
Who do CHCs serve?
More than a third of health center patients are uninsured and almost 40% are covered by Medicaid. Under the Affordable Care
Act (ACA), the number of health center patients is expected to grow significantly, but their uninsured rate is expected to fall.
 In 2011, 1,128 health centers operating in about 8,500 sites provided 80 million visits to about 20 million patients,
primarily for medical care, but also for dental, behavioral health, and enabling services.2
More than 70% of health center patients are below the federal poverty level. Most of the patients treated at CHCs are
working-age adults (60%) and children (33%), and about 7% are seniors. Over half of those served by CHCs are members of
racial or ethnic minority groups. Health centers serve more than 1 in 6 low-income people nationally.
1
2
“2011 National Data: Community Health Centers,” Health Resources and Services Administration
“Community Health Centers,” Kaiser Foundation, March 2013.
How are CHCs paid?
CHCs serve the uninsured and under-insured and are paid based on the following factors:
1. A patient’s ability to pay by using a sliding fee scale based on income.
2. Patients enrolled in Medicare pay CHCs through the program directly based on an all-inclusive per visit payment.
3. Patients enrolled in Medicaid, CHIP or private insurance pay through reimbursement payments based on services
rendered.
Health Center Patients by Source of Insurance, 2010 and 2019 3
3%
8%
Medicaid
14%
39%
2010 (Actual):
Patient Population of 19.5 million
Uninsured
Private
Medicare
Other public
38%
1%
8%
Medicaid
9%
Uninsured
44%
14%
2019 (Projected):
Patient Population of 40
million
Private
Exchange
Medicare
22%
Other public
How are CHCs funded?
CHCs are funded through federal grants. Recipients of CHC grant funds are legislatively required to meet the federal criteria
for Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs). MUAs are determined by the
Index of Medical Underservice (IMU) which measures numerous factors such as:




The Number of Physicians
Infant Mortality Rate
Poverty Level
The Elderly Population
*For more information and specifics on how service areas are identified, see page 3 of this document.
3
“Community Health Centers,” Kaiser Foundation, March 2013.
How have CHCs changed in the last 10 years?
Patient visits to CHCs increased from 38 million in 2000 to 80 million in 2011. In this same time period, medical staff doubled
and dental and behavioral health staff nearly tripled.
Under the ACA, the number of health center patients is expected to grow significantly, but their uninsured rate is expected to
fall. Still, the share of their patients who lack coverage will remain high, and health centers will probably serve a larger share of
those who remain uninsured. CHCs capacity is projected to virtually double by 2019, to 40 million patients.
How does the ACA affect CHC payment?
The ACA mandates that health centers will have to use a Federally Qualified Health Center Prospective Payment System that
will be implemented by October 1, 2014. Medicare payments will be issued based on the service provided using the
appropriate revenue code and Healthcare Common Procedure Coding System (HCPCS) code, which are well established for
other provider payment systems.
How does Medicaid expansion affect CHCs?
In the 26 states (including D.C.) that have chosen to expand their Medicaid programs, 42.6% of their CHC patients have been
covered by Medicaid while only 33.5% of their CHC patients are left uninsured. In the 25 states that have yet to expand their
Medicaid program only 34.1% are covered by Medicaid while 41.1% of their CHC patients are left uninsured4.
How are CHCs involved in Health Insurance Exchange enrollment?
The federal government distributed $156 million to CHCs last year in order to double the number of staff positions to assist
Medicaid and private plan enrollment nationwide. They also allocated $58 million in states that didn’t expand Medicaid with
only federal-run exchanges to do the same.
Additional Resources



Health Resources and Services Administration
Centers for Medicare and Medicaid Services
National Association of Community Health Centers
What determines where CHCs can operate?
Recipients of CHC grant funds are legislatively required to serve MUAs and MUPs. MUAs are determined by the Index of
Medical Underservice (IMU) which measures a service area based the criteria outlined on page 2.
If the service area is below a certain level on the IMU, it qualifies as a MUA. MUPs are also determined by the IMU by
applying data on an underserved population group within an area of residence. Population groups requested for MUP
designation are those with economic barriers or cultural and/or linguistic barriers to primary medical care services.
Exceptions to the MUP designation requirements can be made based on unusual local conditions which may prevent access to
personal health services, if they exist and are documented.
4
"How Medicaid Expansions and Future Community Health Center Funding Will Shape Capacity to Meet the Nation’s Primary Care
Needs." George Washington University School of Public Health and Health Services, 2013.

Download Report