Community Health Centers' Experiences in a More Mature ACA Market

The 2018 Survey of Community Health Centers’ Experiences and Activities under the Affordable Care Act was conducted by the Geiger Gibson Program in Community Health Policy at the George Washington University (GW) and the Kaiser Family Foundation Program on Medicaid and the Uninsured, with input from the National Association of Community Health Centers (NACHC). The purpose of this survey was to assess the experiences of community health centers in a more mature ACA market. The survey focused on three key issues: (i) health centers’ role in health insurance outreach and enrollment; (ii) how health centers are evolving under the ACA and the financial, professional, and patient care-related challenges they face; and (iii) how health centers are approaching the opioid crisis and the treatment options that are available. A report presenting findings on the role health centers play in addressing the opioid epidemic was published separately.

The online survey was emailed to all CEOs of federally funded community health centers (n=1,337) in the 50 states and the District of Columbia (DC) identified in the 2016 Uniform Data System (UDS), to which all health centers must report annually. The survey was fielded from early January to late February 2018. There were a total of 489 survey responses from 49 states and DC, resulting in a response rate of 37%. Survey respondents and non-respondents were compared on the basis of 2016 UDS variables. Comparisons of 2016 UDS data found no significant differences between survey respondents and non-respondents for location in rural or urban locations, location in Medicaid expansion states, the number of patients served and clinic visits, the percentage of patients who are low-income, the percentage of patients by insurance type, or average total revenue. However, there were significant differences by the percentage of patients who are racial/ethnic minorities, the ratio of total staff FTEs to 10,000 patients, and the total revenue per patient.

The survey data was weighted using 2016 UDS variables for total health center patients, the percentage of their patients reported as racial/ethnic minorities, and total revenue per patient. Bivariate analyses (t-tests and X2 tests) were conducted to test for significant differences by Medicaid expansion status. Findings are presented for all respondents and by location in states that expanded Medicaid and in non-expansion states.

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