The federal health center program, authorized in Section 330 of the
Public Health Service Act, awards grants to support health centers:
outpatient primary care facilities that provide care to primarily
low-income individuals. The program-administered by the Health
Resources and Services Administration (HRSA) within the Department
of Health and Human Services (HHS)-supports four types of health
centers: (1) community health centers; (2) health centers for the
homeless; (3) health centers for residents of public housing; and
(4) migrant health centers. According to HRSA data, there are over
8,633 unique health center sites (i.e., unique health center
facility locations). Facilities must meet a number of requirements
to receive a Section 330 grant, but receiving these grants enables
health centers to receive services or in-kind benefits from a
number of federal programs. Appropriations for the health center
program have increased over the past decade, resulting in more
centers and more patients served. From FY2000 through FY2012 the
health center program's appropriation increased by 48%. Over this
same time period, the number of health center sites increased by
59%. The program also received supplemental appropriations through
the American Recovery and Reinvestment Act (P.L. 111-5) in FY2009.
The program's expansion may continue under the Patient Protection
and Affordable Care Act of 2010 (P.L. 111-148, ACA), which
permanently authorized the health center program and created the
Community Health Center Fund (CHCF) that included a total of $9.5
billion for health center operations to be appropriated in FY2011
through FY2015. However, it is not clear whether these funds will
be used to expand the health center program because in FY2011,
FY2012, and the FY2013 President's Budget request, these funds were
or would be used to augment discretionary appropriation reductions
to the health center program. Health centers are required to
provide health care to all individuals regardless of their ability
to pay and are required to be located in geographic areas that have
few health care providers. These requirements make health centers
part of the health safety net-providers that serve the uninsured,
the underserved, or those enrolled in Medicaid. Data compiled by
HRSA demonstrate that health centers serve the intended safety net
population as the majority of patients are uninsured or enrolled in
Medicaid. Some research also suggests that health centers are a
cost effective way of meeting this population's health needs
because researchers have found that patients seen at health centers
have lower health care costs than those served in other settings.
In general, research has found that health centers, among other
outcomes, improve health, reduce costs, and provide access to
health care for populations that may otherwise not obtain health
care. This report provides an overview of the federal health center
program including its statutory authority, program requirements,
and appropriation levels. The report then describes health centers
in general, where they are located, their patient population, and
some outcomes associated with health center use. It also describes
some federal programs available to assist health center operations
including the federally qualified health center (FQHC) designation
for Medicare and Medicaid payments. The report then concludes with
a brief discussion of issues for Congress such as the potential
effects of the ACA on health centers, the health center workforce,
and financial considerations for health centers in the context of
changing federal and state budgets. Finally, the report has two
appendixes that describe (1) FQHC payments for Medicare and
Medicaid beneficiaries served at health centers; and (2) programs
that are similar to health centers but not authorized in Section
330 of the PHSA.
General
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