Community Health Centers: Growing Importance in a Changing Health Care System
Community health centers are a key component of our health care system, providing essential access to comprehensive primary care in underserved communities. The health center program has experienced significant growth over time, particularly since the enactment of the Affordable Care Act (ACA), which expanded coverage options for many low-income health center patients and provided increased funding for health centers through the Community Health Center Fund (CHCF). With the enhanced ACA funding, health centers have expanded their service delivery capacity to meet the growing demand for care among new and existing patients. Drawing on federal health center data from 2016 and the Health Center Patient Survey from 2009 and 2014, this brief describes health centers and their patients in 2016 and examines changes in access to care and utilization of services by health center patients following implementation of the ACA coverage expansions in 2014. Key findings include:
- Health centers are an important source of primary care for Medicaid and uninsured patients. In 2016, health centers served 25.9 million patients at over 10,400 urban and rural locations. Just under half (49%) of health center patients were covered by Medicaid and nearly a quarter (23%) were uninsured. Nationally, one in six Medicaid enrollees received care at a health center.
- Medicaid and Federal Section 330 grant funds account for the majority of health center revenues. Medicaid is the largest source of funding for health centers, accounting for 43% of total health center revenue. Federal grants represent the next largest source of funding at 19%. These federal grant funds support care to uninsured and underinsured patients and enable health centers to provide services not covered by other payers. Health centers in states that did not expand Medicaid under the ACA are more reliant on federal grant funds. For these health centers, federal grant funding accounts for over a quarter of total revenues.
- Health centers in Medicaid expansion states have greater operational capacity and serve more patients than health centers in non-expansion states. State decisions on the Medicaid expansion have had service delivery implications for health centers. Health centers in Medicaid expansion states reported higher Medicaid revenues on average and higher revenues overall than health centers in non-expansion states. These higher revenues enabled health centers in expansion states to serve over a quarter more patients and provide nearly 50% more patient visits. Health centers in expansion states also employed more staff on average and were more likely to provide a broader array of services, including mental health, substance use disorder, and vision services.
- The ability of health center patients to access needed care improved following implementation of the ACA coverage expansions. Despite concerns raised by policy experts that the ACA coverage expansions would lead to an inability to get needed care and longer waits for care, fewer health center patients reported facing barriers to care in 2014 compared to 2009. The share of patients reporting an inability to obtain needed medical care dropped by one-third (from 23% to 15%) and the share reporting a delay in getting needed care dropped by over a quarter. Patients reported similar improvements in access to dental care, and these improvements occurred for both Medicaid and uninsured patients.
- Utilization of certain preventive services by health center patients increased. Along with improvements in accessing needed care, health center patients also reported increased utilization of certain preventive services, including flu shots and physical exams. Over half of adult health center patients said they received a flu shot in 2014, up from just 39% in 2009. Nearly 7 in 10 reported receiving a physical exam in 2014 compared to 63% in 2009. Uninsured patients were also significantly more likely to have received a dental exam in 2014 than in 2009 (42% vs. 33%).