History of Community Health Centers

History of Community Health History of Community Health CentersCenters

In the 1960s, as President Johnson's In the 1960s, as President Johnson's declared "War on Poverty" began to declared "War on Poverty" began to

ripple through America, the first ripple through America, the first proposal for the U.S. version of a proposal for the U.S. version of a

community health center sprung to community health center sprung to life at the Office of Economic life at the Office of Economic

Opportunity. Funding was approved Opportunity. Funding was approved in 1965 for the first two in 1965 for the first two

neighborhood health center neighborhood health center demonstration projects, one in demonstration projects, one in Boston, Massachusetts, and the Boston, Massachusetts, and the

other in Mound Bayou, Mississippiother in Mound Bayou, Mississippi. .

Congress also helped stake out this new direction Congress also helped stake out this new direction in health care by passing several pieces of in health care by passing several pieces of

legislation:legislation:

Social Security Act was amended with the passage of Social Security Act was amended with the passage of

the Kerr-Mills measure (1960),the Kerr-Mills measure (1960), provided states with grant money for the medically provided states with grant money for the medically

indigent. indigent. • Two years later, Migrant Health Act was signed into Two years later, Migrant Health Act was signed into

lawlaw created rural clinics where migrant workers could created rural clinics where migrant workers could

find health care as they moved from place to place, find health care as they moved from place to place, Passage of the landmark Economic Opportunity Act of Passage of the landmark Economic Opportunity Act of

1964 that marked the birth of America’s Community 1964 that marked the birth of America’s Community Health Centers. Health Centers.

The health center model that The health center model that emerged targeted the roots emerged targeted the roots of poverty by combining the of poverty by combining the

resources of local resources of local communities with federal communities with federal

funds to establish funds to establish neighborhood clinics in both neighborhood clinics in both rural and urban areas around rural and urban areas around

America. America.

It was a formula that: It was a formula that:

Empowered communities. Empowered communities. Generated compelling proof that affordable and Generated compelling proof that affordable and

accessible health care produced compounding accessible health care produced compounding benefits. benefits.

Reduced health disparities. Reduced health disparities. Lowered infant mortality rates. Lowered infant mortality rates. Reduced chronic disease. Reduced chronic disease. Created jobs. Created jobs. Produced cost-savings for the health care system Produced cost-savings for the health care system

by reducing the need for acute care at hospital by reducing the need for acute care at hospital emergency rooms. emergency rooms.

The passage of Medicare and The passage of Medicare and Medicaid in 1965 also provided Medicaid in 1965 also provided much needed benefits to the much needed benefits to the elderly, disabled, and families elderly, disabled, and families

living in poverty. living in poverty.

In 1975, Congress permanently In 1975, Congress permanently authorized neighborhood health authorized neighborhood health

centers as "community and centers as "community and migrant health centers," and in migrant health centers," and in

later years added primary health later years added primary health care programs for residents of care programs for residents of

public housing and the homeless public housing and the homeless to the portfolio of programs. to the portfolio of programs.

The Health Centers The Health Centers Consolidation Act of 1996 Consolidation Act of 1996

combined these authorities combined these authorities under Section 330 of the Public under Section 330 of the Public

Health Service Act (PHSA) to Health Service Act (PHSA) to create the consolidated health create the consolidated health centers program and what is centers program and what is now known as Community, now known as Community, Migrant, Public Housing and Migrant, Public Housing and Homeless Health Centers. Homeless Health Centers.

The Health Resources and The Health Resources and Services Administration (HRSA), Services Administration (HRSA), Bureau of Primary Health Care Bureau of Primary Health Care

(BPHC) currently administers the (BPHC) currently administers the program, within the U.S. program, within the U.S.

Department of Health and Department of Health and Human Services (HHS). Human Services (HHS).

Health centers: Health centers:

Now constitute an integral part of the Now constitute an integral part of the nation’s health delivery system. nation’s health delivery system.

Is the only health care system Is the only health care system controlled in partnership with patients. controlled in partnership with patients.

Governed by a community board with a Governed by a community board with a patient majority-- a patient democracy. patient majority-- a patient democracy.

Patients do not just pay for their health Patients do not just pay for their health care, they also "have a say" in how their care, they also "have a say" in how their health care is delivered. health care is delivered.

The patient-majority governing The patient-majority governing board is among the five core board is among the five core statutory requirements that statutory requirements that

every health center must meet every health center must meet in order to receive federal in order to receive federal

funding. funding.

The other requirements are: The other requirements are:

Location in a federally designated medically Location in a federally designated medically underserved area. underserved area.

Have nonprofit, public, or tax exempt status. Have nonprofit, public, or tax exempt status. Provide comprehensive primary health care Provide comprehensive primary health care

services, referrals and other services needed services, referrals and other services needed to facilitate access to care, such as case to facilitate access to care, such as case management, translation, and management, translation, and transportation. transportation.

Provide services to all in their service area, Provide services to all in their service area, regardless of ability to pay, and offer a regardless of ability to pay, and offer a sliding fee schedule that adjusts charges for sliding fee schedule that adjusts charges for care according to family income. care according to family income.

Today, almost forty years after Today, almost forty years after they started: they started:

America's health centers are helping America's health centers are helping communities meet escalating health needs communities meet escalating health needs and address costly and devastating health and address costly and devastating health problems. problems.

Health centers and their innovative programs Health centers and their innovative programs in primary care and prevention span urban in primary care and prevention span urban and rural communities across the nation. and rural communities across the nation.

serve as the family doctor and health care serve as the family doctor and health care home for more than 15 million people.home for more than 15 million people.

What are Health Centers?What are Health Centers?

Community health centers are Community health centers are local, non-profit, community-local, non-profit, community-owned health care providersowned health care providers

serving low income and serving low income and medically underserved medically underserved

communities. communities.

The national network of health The national network of health centers have provided centers have provided high-high-

quality, affordable primary quality, affordable primary care and preventive servicescare and preventive services, , and often provide on-site dental, and often provide on-site dental,

pharmaceutical, and mental pharmaceutical, and mental health and substance abuse health and substance abuse

services.  services. 

Known as Federally-Qualified Known as Federally-Qualified Health Centers (FQHCs), they Health Centers (FQHCs), they

are located in areas where care are located in areas where care is needed but scarce, and is needed but scarce, and

improve accessimprove access to care for to care for millions of Americans regardless millions of Americans regardless

of their insurance status or of their insurance status or ability to pay.  ability to pay. 

Federally-Qualified Health Federally-Qualified Health Centers (FQHCs):Centers (FQHCs):

Their costs of care rank among the Their costs of care rank among the lowest. lowest.

Reduce the need for more expensive Reduce the need for more expensive in-patient and specialty care. in-patient and specialty care.

Save billions of dollars for taxpayers.Save billions of dollars for taxpayers.Over 1,000 community, migrant, and Over 1,000 community, migrant, and

homeless health centers serve 3,600 homeless health centers serve 3,600 urban and rural communities in every urban and rural communities in every state and territory. state and territory.

Who Do Health Centers Who Do Health Centers Serve? Serve? 

Health centers serve:Health centers serve: As the medical home and family physicianAs the medical home and family physician toto 15 15

million people million people nationally. nationally. Patients are among the nation’s most vulnerable Patients are among the nation’s most vulnerable

populations. populations. Half of health center patients reside in rural areas. Half of health center patients reside in rural areas. One in five low income children.One in five low income children. Nearly 70% of health center patients have Nearly 70% of health center patients have

family incomes at or below poverty.family incomes at or below poverty. Nearly 40% of health center patients are Nearly 40% of health center patients are

uninsured and another 36% depend on uninsured and another 36% depend on Medicaid.Medicaid.

Two-thirds of health center patients are Two-thirds of health center patients are members of racial and ethnic minoritiesmembers of racial and ethnic minorities..

How Do Health Centers How Do Health Centers Overcome Barriers To Care?Overcome Barriers To Care?

They: They:

Located in high-need areas.Located in high-need areas. Open to all residents.Open to all residents. Tailor their services Tailor their services to fit the to fit the

special needs and priorities of their special needs and priorities of their communities. communities.

OfferOffer services that help their services that help their patients access health care.patients access health care.

For many patients, the health For many patients, the health center may be the only source of center may be the only source of health care services available.  health care services available. 

In fact, the number of uninsured In fact, the number of uninsured patients at health centers is patients at health centers is

rapidly growing – from around rapidly growing – from around 3.93.9 million in 1998 to over 5.9 million in 1998 to over 5.9

million today. million today.

How Do Health Centers Make How Do Health Centers Make A Difference?A Difference?

Key to health centers’ Key to health centers’ accomplishments is accomplishments is patient patient

involvement in service involvement in service

delivery.delivery. Governing boards – the majority of Governing boards – the majority of

which must be patients according to which must be patients according to grant requirements – manage health grant requirements – manage health center operations.  Board members center operations.  Board members serve as community representatives serve as community representatives

and make decisions on services and make decisions on services provided.  Active patient provided.  Active patient

management of health centers management of health centers assures responsiveness to local assures responsiveness to local

needs. needs.

Health centers improve the quality of life Health centers improve the quality of life for millions of patients in the following for millions of patients in the following

ways:ways:

Improve Access to Primary and Improve Access to Primary and Preventive CarePreventive Care

Effective Management of Chronic Effective Management of Chronic IllnessIllness

Reduction of Health DisparitiesReduction of Health Disparities Cost-Effective CareCost-Effective Care High Quality of CareHigh Quality of Care Fewer Infant DeathsFewer Infant Deaths Create Jobs and Stimulate Economic Create Jobs and Stimulate Economic

GrowthGrowth

Why Is Investing In Health Why Is Investing In Health Centers Important?Centers Important?

Investing in health centers produces:Investing in health centers produces:

Improved health outcomes and quality of life. Improved health outcomes and quality of life. Reductions in health disparities for millions of Americans Reductions in health disparities for millions of Americans Leads to reductions in national health care spending. Leads to reductions in national health care spending. On average receive only 26% of their total revenue from On average receive only 26% of their total revenue from

federal grants. federal grants. Largest single source of revenue is Medicaid:Largest single source of revenue is Medicaid:

Representing 36% of total revenue and 64% of all Representing 36% of total revenue and 64% of all patient-related revenue.  patient-related revenue. 

Cited as one of the 10 most successful federal programsCited as one of the 10 most successful federal programs Expanded investment in health centers will guarantee Expanded investment in health centers will guarantee

improved health outcomes for millions more Americans improved health outcomes for millions more Americans and further cost savings. and further cost savings.