A new policy brief by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at Milken Institute School of Public Health documents steady growth at the nation’s 1,362 community health centers, highlighting the importance of the Affordable Care Act (ACA) Medicaid expansion and continued grant funding.

The report, based on newly released data from the U.S. Department of Health and Human Services Uniform Data System, examines health center activity for 2018 and comparative years. The authors find that the total number of patients served by community health centers (CHCs) nearly tripled from 2000 to 2018 – from 9.6 million to 28.4 million patients – while the number of Medicaid patients served quadrupled, to cover 48% of all patients in 2018. While this growth is attributable to several factors, key among them is the Affordable Care Act (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, with the percentage of uninsured patients across all health centers declining, from 35% in 2013 to 23% in 2018. Still, key differences persist between Medicaid expansion and non-expansion states: by 2018, the proportion of uninsured patients served by health centers in non-expansion states was nearly twice as high (35%) as in expansion states (18%). Meanwhile, 55% of patients served by expansion-state CHCs were covered by Medicaid in 2018, compared to 32% in non-expansion states.

Increasingly, health centers have added services to meet the changing needs of the communities they serve. Nearly all health centers (95%) offered mental health care in 2018, and half provided substance use disorder services, compared to 73% and 20%, respectively, in 2010. 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. In 2018, health centers also 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.

Yet 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. These include current 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. The authors warn that funding instability can seriously disrupt the provision of those very services that help keep entire communities healthy.

The issue brief, part of the Geiger Gibson/RCHN Community Health Foundation’s signature policy series, “Community Health Centers Continue Steady Growth, But Challenges Loom” can be accessed here.