Community Health Centers Continue Steady Growth But Challenges Loom
WASHINGTON, DC and NEW YORK, NY (Sept. 26, 2019) – More than 28 million people, one in 12 nationwide, received care at one of the nation’s 1,362 community health centers during 2018, showing steady growth and highlighting the importance of the Affordable Care Act (ACA) Medicaid expansion, according to a new study by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).
The report, issued as part of the Collaborative’s signature policy brief series with the RCHN Community Health Foundation, examined health centers and their growth during 2018. The report is based on newly released data from the U.S. Department of Health and Human Services Uniform Data System, an annual reporting system offering in-depth information about community health centers.
The total number of patients served by community health centers nearly tripled from 2000 to 2018 – from 9.6 million to 28.4 million patients – while the number of Medicaid patients served quadrupled, covering 48 percent of all patients in 2018. While this growth can be attributed to several factors, key among them is the ACA Medicaid expansion. Even in those states that have not adopted the ACA Medicaid expansion, more patients are covered as a result of streamlined health insurance and renewal and expanded outreach. Between 2013 and 2018, the percentage of uninsured patients across all health centers declined, from 35 percent to 23 percent, but there are key differences between Medicaid expansion and non-expansion states. From 2013 to 2018, the number of uninsured patients served by health centers in non-expansion states increased by four percent, while it declined by 26 percent in expansion states. By 2018, the proportion of uninsured patients served by health centers in non-expansion states was nearly twice as high (35 percent) as in expansion states (18 percent). Meanwhile, 55 percent of patients served by expansion-state health centers were covered by Medicaid in 2018, compared to 32 percent in non-expansion states.
Increasingly, health centers have added services to meet the changing needs of the communities they serve. While two-thirds of patients use health centers for medical care, dental care accounted for one in seven visits during 2018, and visits for mental health and substance use disorder services accounted for one in nine. Nearly all health centers (95 percent) offered mental health care in 2018, and half provided substance use disorder services, compared to 73 percent and 20 percent, respectively, in 2010. In 2018, health centers provided medication-assisted treatment to nearly 95,000 patients with opioid use disorder. This rapid growth in services and expansion of care options can be tied to dedicated federal grant funding from the Health Resources and Services Administration to increase access to mental health and substance use disorder services, and address the escalating opioid crisis.
“In 2018, community health centers continued to increase their patient and service capacity, particularly for mental health and substance use disorder services,” said Jessica Sharac, MSc, MPH, research scientist at Milken Institute SPH, one of the authors of the analysis. “Today’s health centers play a crucial role in providing comprehensive primary health care – everything from immunizations and regular check-ups to care for the elderly.”
Despite the significant growth in both capacity and scope, reflecting access to both Medicaid and grant funding, the authors caution that community health centers are vulnerable to major federal policy decisions that directly affect the health care safety net, including uncertainty regarding the future of the Community Health Center Fund, the administration’s “public charge” rule, changes to the Title X family planning program, and Medicaid work requirement programs.
“Community health centers are anchoring institutions, and rely on stable funding to provide health care to millions of people living in diverse, high-need urban and rural communities,” said Feygele Jacobs, DrPH, President and CEO of the RCHN Community Health Foundation, whose ongoing gift supports the Geiger Gibson Program. “Funding instability can seriously disrupt the provision of services that help keep entire communities healthy.”