A new policy brief by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University’s Milken Institute School of Public Health documents steady growth at the nation’s community health centers through 2019, highlighting the importance of the Affordable Care Act (ACA) Medicaid expansion and the need for not only emergency relief, but continued, stable long-term 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 2019 and comparative years. In 2019, on the eve of the public health emergency, the total number of patients served by community health centers (CHCs), including both federally-funded CHCs as well as “look-alike” health centers, surpassed 30 million. From 2000 to 2019, the number of Medicaid patients served by federally-funded community health centers increased by 341 percent, a key indicator of the impact of the ACA Medicaid expansion on access to health insurance among the poorest Americans. The report further finds key differences between Medicaid expansion and non-expansion states. In expansion states, the proportion of Medicaid-insured patients grew from 41 percent to 53 percent between 2010 and 2019; by contrast, in non-expansion states, the proportion grew from a much lower initial level of 31 percent to only 32 percent. In 2019, moreover, the proportion of uninsured patients served by health centers in non-expansion states was twice as high (36 percent) as in Medicaid expansion states (18 percent). The additional revenue in Medicaid expansion states means that community health centers in these states are substantially larger and better staffed and offer a broader range of services.

The 2019 data provide a snapshot of community health centers before the beginning of the worst pandemic in a century; since the start of the COVID-19 crisis, community health centers have played a vital role in making COVID-19 testing and care available in the poorest and most at-risk communities. Yet recent data show the continuing impact of the pandemic on health center operations, staffing and revenue, with nearly 1 in 14 sites closed, and visits down by 20 percent. The authors estimate that between April and August 2020, community health centers nationally have lost a total of nearly $2.9 billion, approximately nine percent of total revenue reported in 2019. Emergency payments for COVID-19 testing and treatment have provided some limited relief, but revenue losses can quickly be expected to exceed whatever short-term relief has been provided. Exacerbating the near-term crisis is the status of the Community Health Center Fund, which accounts for more than 70 percent of all ongoing federal grant funding; the Fund is set to expire at the end of November 2020 and has yet to be extended.

Given their deep local roots and longstanding record of service, it is not surprising that community health centers have emerged as an indispensable resource in fighting the coronavirus pandemic, but both short-term relief and secure, long-term funding are essential if health centers are to maintain growth in capacity and services. Keeping our at-risk communities healthy means supporting the health center organizations on the front lines.

Read the new brief, part of the Geiger Gibson/ RCHN Community Health Foundation’s signature policy series, “Community Health Centers on the Eve of the COVID-19 Pandemic: An Overview of Findings from the 2019 Uniform Data System