© National Association of Community Health Centers

United States

Health Center

Fact Sheet

What are Health Centers? Community, Migrant, and Public Housing Health Centers are non-profit, community-directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, cultural and other barriers. Also known as Federally-Qualified Health Centers (FQHCs), they:

are located in high-need areas identified as having elevated poverty, higher than average infant mortality, and where few physicians practice;

are open to all residents, regardless of insurance status or ability to pay; tailor services to fit the special needs and priorities of their communities, and provide services in a

linguistically and culturally appropriate manner; provide comprehensive primary and other health care services, including services that help their patients

access care, such as transportation, translation, and case management; provide high quality care, reducing health disparities and improving patient outcomes;1 and are cost effective, reducing costly emergency, hospital, and specialty care, and saving the health care system

$24 billion a year nationally.2

US Federally-Supported Health Centers, 2012

Number of Organizations 1,198

Number of Delivery Sites 8,912

Total Patients 21,102,391

Number Migrant/Seasonal Farmworker Patients 903,089

Number Homeless Patients 1,121,037

Population Characteristics3

Health Center

Population

US Population

Percent at or Below 100% of Poverty 72% 20%

Percent Under 200% of Poverty 93% 40%

Percent Uninsured 36% 15%

Percent Medicaid 40% 16% Percent Medicare 8% 14%

Percent Hispanic/Latino 40% 17%

Percent African American 24% 13%

Percent Asian/ Native Hawaiian/Pacific Islander 5% 5%

Percent American Indian/Alaska Native 1% 1%

Percent White 66% 78%

Percent Rural 36% 16%

Percent of Vulnerable US Residents Served by Federally-Supported Health Centers4 Percent of Low Income, Uninsured, 2012 24% Percent of Medicaid Beneficiaries, 2012 15% Percent of Population at or Below 100% of Poverty, 2012 19%

© National Association of Community Health Centers

Patient Visits and Patients by Selected Primary

Diagnoses and Services5 Medical Conditions

Patient Visits

Patients

Hypertension 8,757,760 3,402,868 Diabetes mellitus 5,970,535 1,777,364 Heart Disease (Selected) 1,436,115 546,077 Asthma 1,893,763 1,010,145 Depression & Other Mood Disorders 4,543,848 1,436,409

Preventive Services Health Supervision Ages 0-11 4,025,306 2,568,346 Selected Immunizations 3,743,063 2,673,131 Oral Dental Exams 4,542,990 3,429,455 Pap Test 2,020,870 1,873,507 Mammogram 397,404 369,953 Hepatitis B and C Test 648,627 550,175 HIV Test 1,099,241 999,484

Health Center Staff and Related Patient Visit6

FTE

Patient Visits Physicians 10,444.7 35,453,435 NPs/PAs/CNMs 7,555.0 21,228,864 Nurses 12,551.2 3,163,758 Dentists 3,326.0 8,837,458 Dental Hygienists 1,435.6 1,854,820 Mental Health Specialists 5,215.1 5,267,380 Pharmacy 3,263.8 N/A Total Enabling Services 13,143.2 5,158,479 Vision 340.0 503,800 Other Staff 90,970.6 2,298,159 Total Staff 148,245.1 83,766,153

Health Centers Providing Select Services Onsite7

Professional Services General Primary Medical Care 99%

Prenatal and Perinatal Care 65% Dental Care 76%

Mental Health and/or Substance Abuse Services 74%

Vision 19%

Pharmacy 39% Preventive Services

HIV Testing And Counseling 79% Cervical Cancer Screening 98% Breast Cancer Screening 66% Health Supervision for Infants and Children 96% Smoke and Tobacco Use Cessation Counseling 63%

Enabling Services

Case Management 64%

Eligibility Assistance 56% Health Education 53% Interpretation/Translation Services 25% Transportation 22% Outreach 59%

Health Centers Providing Select Services Onsite8

Average Cost per Patient

Medical Costs per Medical Patient $473

Dental Costs per Dental Patient $408

Total Cost per Total Patient $687

Average Cost per Patient Visit

Medical Cost per Medical Patient Visit $150

Dental Costs per Dental Patient Visit $165

United States Health Center Fact Sheet, 2012 Data for federally-funded health centers only and may therefore underreport the true volume of care. See note below.

3 Race/Ethnicity may sum over 100% due to independent calculation of race and ethnicity. Hispanic ethnicity may be of any race. 0% may indicate <0.5%. Source for State and US

Population for Race and Ethnicity: U.S. Census Bureau, Population Division: “Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States,

States, and Counties: April 1, 2010 to July 1, 2012” Released June 2013. Source for Health Coverage, Poverty, Rural data: Kaiser Family Foundation, State Health Facts Online.

www.statehealthfacts.org. Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2012 and 2013 Current Population

Survey (CPS: Annual Social and Economic Supplements). Rural calculation for health centers calculated using 2012 Uniform Data System (UDS). 4 Percent Vulnerable Residents is estimated using 2012 UDS as the numerator. Low-Income Uninsured assumes all health centers’ uninsured patients are low-income given 93% of

health center patients are below 200% of poverty. Source for Low-Income Uninsured and Population at or Below 100% of Poverty: Kaiser Family Foundation, State Health Facts

Online. www.statehealthfacts.org. Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2012 and 2013 CPS: Annual

Social and Economic Supplements. Medicaid Beneficiaries: Kaiser Family Foundation, State Health Facts Online. www.statehealthfacts.org. Monthly Medicaid Enrollment- June 2012.

Compiled by Health Management Associates (HMA) from state Medicaid enrollment reports for the Kaiser Commission on Medicaid and the Uninsured (KCMU). 5 Health Supervision is also known as well child visits. Selected Immunizations include Hepatitis A, Hemophilus Influenza B (HiB), Influenza virus, Pneumococcal Diptheria, Tetanus,

Pertussis (DTaP) (DTP) (DT), Mumps, Measles, Rubella, Poliovirus, Varicella, Hepatitis B Child.

6 FTE is Full-Time Equivalent. Not all staff categories have related visits. Mental Health Specialists include mental health specialists and excludes other substance abuse staff. Total

Enabling Services includes outreach workers, health educators, case managers, interpreters, transportation, eligibility assistance workers, and other enabling services staff. 7 “Onsite” services include services rendered by employers, contracted providers, volunteers and others who render services in the health center’s name. Professional and Enabling

Onsite Services are based on Table 5 with health centers employing more than zero FTEs with the exception of Prenatal and Prenatal Care which is based on Table 6B with health

centers having at least one prenatal patient. Preventive Services are based on Table 6A for health centers with at least one patient visit. Eligibility Assistance is providing assistance in

securing access to available health, social service, pharmacy and other assistance programs, including Medicaid, WIC, SSI, food stamps, TANF, Pharmacy Assistance Programs, and

related assistance programs. 8Medical Cost per Medical Patient excludes lab and x-ray costs. Total Cost per Total Patient includes the total cost of all services over total users. Medical Cost per Medical Visit

excludes lab and x-ray costs and nurse visits.

For more information, email research@nachc.org or visit .

This publication was supported by Grant/Cooperative Agreement Number U30CS16089 from the Health Resources and Services Administration, Bureau of Primary Health

Care (HRSA/BPHC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA/BPHC

Sources and Notes

Note: Unless otherwise specified, this fact sheet is based on Bureau of Primary

Health Care, HRSA, DHHS, 2012 Uniform Data System (UDS). It includes

data from Federally-Qualified Health Centers (FQHCs) that receive federal

health center grants and are therefore required to report administrative, clinical

and other information. Data do not account for a category of FQHCs that does

not receive these funds, known as FQHC Look-Alikes. In 2012 there was 93

FQHC Look-Alikes across the United States. Consequently, data reflected in

this fact sheet may underreport the true volume of care delivered by health

centers. 1 See Summaries of Literature on Health Centers, Quality of Care,

www.nachc.com/research. 2 GWU, Using Primary Care to Bend the Curve: Estimating the Impact of a

Health Center Expansion on Health Care Costs, September 2009,

www.gwhealthpolicy.org

Health Centers Serve All Ages

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Uniform Data System, 2013.

The Affordable Care Act and Health Centers For more than 45 years, health centers have delivered comprehensive, high‐quality preventive and primary health care to patients regardless of their ability to pay. During that time, health centers have become the essential primary care medical home for millions of Americans including some of the nation’s most vulnerable populations. With a proven track record of success, health centers will play a key role in implementation of the Affordable Care Act.

Delivery of Care: Increased Access to Health Services Today, nearly 1,300 health centers operate over 9,200 service delivery sites that provide care to more than 21.7 million patients in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. Overall, since the beginning of 2009, health centers have increased the total number of patients served on an annual basis by nearly 5 million people, increasing the number of patients served from 17.1 million to 21.7 million annually. During this time, health centers have also added more than 43,000 new full‐time positions, increasing their employment from 113,000 to more than 156,000 staff nationwide. This network of health centers has created one of the largest safety net systems of primary and preventive care in the country with a true national impact.

• Health centers, supported by the Health Resources

and Services Administration (HRSA), treated approximately 21.7 million people in 2013, sixty‐two percent of whom are members of ethnic and minority groups. Thirty‐five percent have no health insurance; thirty‐two percent are children.

• One out of every 15 people living in the U.S. now relies on a HRSA‐funded clinic for primary care.

• Health centers are an integral source of local employment and economic growth in many underserved and low‐income communities. Total health center employment is more than 156,000 individuals nationwide, and health centers added more than 43,000 jobs over the last five years.

• Health centers employ more than 10,700 physicians and more than 8,000 nurse practitioners, physician assistants, and certified nurse midwives in a multi‐disciplinary clinical workforce designed to treat the whole patient through culturally‐competent, accessible, and integrated care.

Health center quality of care equals and often surpasses that provided by other primary care providers. A programmatic emphasis on quality improvement as well as community‐responsive and culturally appropriate care has also translated into impressive reductions in health disparities for health center patients. Calendar Year 2013 Health Center Program

data demonstrate that centers continue to provide high quality care and improve patient outcomes, while reducing disparities, despite serving a population that is often sicker and more at risk than seen nationally:

• In 2013, the percent of low birthweight babies, at 7.3 percent, continues to be lower than national estimates (7.99 percent).

• The rate of entry into prenatal care in the first trimester increased from 65 percent in 2008 to 72 percent in 2013.

• 69 percent of health center patients demonstrated control over their diabetes with a hemoglobin A1c (HbA1c) level less than or equal to 9.

• 64 percent of hypertensive health center patients have their blood pressure under control. Health centers also reduce costs to health systems; the health center model of care has been shown to reduce the use of costlier providers of care, such as emergency departments (EDs) and hospitals.

The Affordable Care Act: The Essential Role of Community Health Centers The Affordable Care Act established the Community Health Center Fund that provides $11 billion over a 5 year period for the operation, expansion, and construction of health centers throughout the Nation.

• $9.5 billion is targeted to: o Support ongoing health center operations. o Create new health center sites in medically underserved areas. o Expand preventive and primary health care services, including oral health, behavioral health, pharmacy,

and/or enabling services, at existing health center sites. • $1.5 billion will support major construction and renovation projects at community health centers

nationwide. Health centers are poised to play an essential role in the implementation of the Affordable Care Act. In particular, health centers emphasize coordinated primary and preventive services or a “medical home” that promotes reductions in health disparities for low‐income individuals, racial and ethnic minorities, rural communities and other underserved populations. Health centers place emphasis on the coordination and comprehensiveness of care, the ability to manage patients with multiple health care needs, and the use of key quality improvement practices, including health information technology. The health center model also overcomes geographic, cultural, linguistic and other barriers through a team‐ based approach to care that includes physicians, nurse practitioners, physician assistants, nurses, dental providers, midwives, behavioral health care providers, social workers, health educators, and many others.

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Affordable Care Act Funding for Health Centers To date in FY 2014, through the Affordable Care Act, the Health Center Program awarded or announced the following new funding:

• Health Center Expanded Services Supplemental Funding– In September 2014, HRSA awarded $295.5 million in formula‐based supplements through the Affordable Care Act to 1,195 community health centers in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin to help expand service hours, hire more medical providers, and add oral health, behavioral health, pharmacy, and vision services to reach an estimated 1.5 million new patients nationwide, including over 137,000 oral health patients and more than 38,000 behavioral health patients.

• Health Center Patient‐Centered Medical Home Capital funding opportunity: In August 2014, HRSA awarded $35.7 million in Affordable Care Act funding to 147 health centers in 44 states, the District of Columbia, and Puerto Rico to support patient‐centered medical homes through new construction and facility renovations.

• Health Center Mental Health Service Expansion ‐ Behavioral Health Integration Awards: In

July 2014, HRSA awarded $54.6 million in Affordable Care Act funding to support 221 health centers in 46 states, the District of Columbia and Puerto Rico to establish or expand behavioral health services for over 450,000 people nationwide. Health centers will use these funds for efforts such as hiring new mental health professionals, adding mental health and substance use disorder health services, and employing integrated models of primary care.

• Supplemental Funding Awards to Increase HIV Prevention and Care among Health Centers

Partnering with State Health Departments – In July 2014, HRSA announced the availability of approximately $11 million, through the Affordable Care Act and the Secretary’s Minority AIDS Initiative Fund, to be awarded to up to 22 health centers to support the integration of high‐quality HIV services into primary care through innovative partnerships between health centers and state health departments in Florida, Massachusetts, Maryland and New York.

• Health Center Outreach and Enrollment Assistance one‐time supplemental funding

opportunity: In December 2013, HRSA awarded approximately $58 million in one‐time supplemental awards under the Affordable Care Act to 1,157 health centers to support ongoing outreach and enrollment activities. These one‐time supplements will allow health centers to meet immediate needs, including expanding the hours of existing outreach and enrollment assistance workers, and hiring new or temporary outreach and enrollment assistance workers.

• Health Center New Access Points: In November 2013, HRSA awarded approximately $150 million to establish 236 new health center access points. These grants support new full‐time service delivery sites for the provision of comprehensive primary and preventive health care services to an additional 1.25 million people.

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In FY 2013, through the Affordable Care Act, the Health Center Program awarded the following funding:

• Health Center Controlled Networks: Approximately $21 million was awarded to 43 network organizations to support the adoption and meaningful use of electronic health records, and the use of other health information technology to improve quality in health centers. These networks must include at least 10 Health Center Program grantees and overall will provide support to more 700 health centers nationwide.

• Health Center Outreach and Enrollment Assistance supplemental funding opportunity: HRSA awarded approximately $150 million in early July to 1,159 health centers in support of outreach and enrollment activities nationwide. These funds are being invested in health centers to expand current outreach and enrollment assistance activities and facilitate enrollment of eligible health center patients and service area residents into affordable health insurance coverage through the Health Insurance Marketplaces, Medicaid or the Children’s Health Insurance Program. The FY 2013 Health Center Outreach and Enrollment Assistance supplemental funding opportunity complements and aligns with other federal efforts, such as the Navigator program, as well as state consumer assistance efforts.

• Health Center New Access Points: In September 2013, HRSA awarded $19 million to establish 32

new health center access points. These grants support new full‐time service delivery sites for the provision of comprehensive primary and preventive health care services.

• Health Center Base Adjustments: HRSA awarded more than $48 million to 1,193 existing health

centers nationwide to support ongoing operations and quality improvement activities. The base adjustments establish a new target level of support for each health center for FY 2014.

School‐Based Health Center Capital Program The Affordable Care Act authorized a new program and appropriated $200 million in funding from 2010 – 2013 to address significant and pressing capital needs to improve delivery and support expansion of services at school‐based health centers. HRSA awarded these funds under the School‐Based Health Center Capital (SBHCC) Program in fiscal years (FYs) 2011, 2012 and 2013 to 520 school‐based health center programs to:

• Create new school‐based health center sites in medically underserved areas; and • Expand preventive and primary health care services at existing school‐based health center

sites. The recipients of the SBHCC funding are expected to develop the capacity to serve an additional 875,000 through the use of the SBHCC funding.

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