Unprecedented Growth: Health Center Expansion 2002-2007

In 2001, President Bush launched the Health Center Growth initiative and set a goal to significantly impact 1,200 communities across the Nation by supporting new or expanded health center sites. This initiative received support from Congress. A few years later in 2007, High Poverty grants were awarded to further ensure health centers expanded to locations where there had previously been none. Since the launch of the initiative in 2002, the goal to significantly increase access has not only been reached but surpassed. With broad support, Federal investments in the Health Center Program have nearly doubled, growing from a little more than $1 billion in 2000 to nearly $2 billion today.

Table 7. Federal Funding for the Health Center Program, 2002-2007

Figure 4. Goal Met: 1236 New and Expanded Access Points

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Source: U.S. Department of Health and Human Services, Health Resources and Services Administration. Rockville, Maryland: HRSA Electronic Handbooks (EHB) Grants Data, 2002-2007.

Opening More Doors to a Health Care Home

• In 2007 the number of patients served passed the 16 million mark for the first time.
• Between 2001 and 2007, the number of patients treated at health centers has increased by nearly 5.8 million, representing a 56 percent increase in just 6 years.
• Looking back even further—over 10 years (1997-2007)—the number of patients served has nearly doubled (increased by 95 percent) while the number of health center grantees grew by almost 60 percent over the same period.
• As a key source of local employment and economic growth in many underserved and low-income communities, health centers have seen their staff grow to over 103,000 full time equivalents, leveraging over $9 billion in needed health services.
• Health centers are also serving an increasing number of special populations, including people experiencing homelessness and migrant and seasonal farmworkers.
  • The number of homeless patients served during this time period (2001-2007) rose by over 428,000, a 75 percent increase.
  • And the number of migrant and seasonal farmworkers during this time (2001-2007) increased by over 140,000, a 20 percent increase.

Table 8. Percent of Patients Uninsured and Below Poverty, 2007*

* Based on preliminary estimates
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Uniform Data System. Rockville, Maryland: U.S. Department of Health and Human Services, 2007.

Expanding Health Center Services

During this tremendous period of growth, health centers have provided more mental health and substance abuse treatment than ever before. In 2007, more than 613,000 patients received mental health and/or substance abuse services at health centers, representing more than triple the number of patients seen over 2001 and a 31 percent increase in substance abuse visits over 2001.

For oral health, in 2007, over 2.8 million patients received dental services at health centers, nearly double the number of dental patients seen in 2001. Health centers provided over 6.7 million dental visits, more than doubling such visits over 2001.

 Health Center Growth Opportunities Opening More Doors to a Health Care Home: New Access Points

New Access Points support the establishment of new service delivery sites for medically underserved populations. Through these grants, organizations offer access to comprehensive primary and preventive health care (including mental health, substance abuse, and oral health care services) and social services to populations currently with limited or no access to such services. Federally funded health centers may offer services to the general community; migrant and seasonal farmworkers and their families; homeless people, including children and families; and public housing residents. All services must be provided to all persons without regard to an individual's ability to pay. Each application for support to establish a new access point must identify a population in need of primary health care services and propose a specific plan to increase access to care and reduce disparities identified in the population or community to be served.

Federally Qualified Health Center Look-Alikes

In 1990, Congress authorized the FQHC Look-Alike Program as a result of limited Federal funding to support the increased demand for health centers to serve the millions of uninsured and underinsured populations throughout the country. Organizations that are approved for FQHC Look-Alike designation do not receive grant funding under section 330 of the Public Health Service Act; however, they operate and provide services similar to grant funded programs. FQHC Look-Alikes are required to meet the statutory, regulatory, and policy requirements of section 330 and demonstrate a commitment to providing primary health care services to medically underserved populations regardless of their ability to pay.

FQHC Look-Alikes receive the following Federal benefits in lieu of section 330 grant funding: (1) enhanced Medicare and Medicaid reimbursement; (2) eligibility to participate in the 340(b) Federal Drug Pricing Program; (3) automatic Health Professional Shortage Area designation; and (4) eligibility to receive National Health Service Corp personnel. These benefits support FQHC Look-Alikes in improving access to culturally-competent, high quality primary health care services for the medically underserved in their community.

The FQHC Look-Alike Program has been an effective additional resource in meeting the increased demand for primary health care delivery systems. What started with 28 organization designated as FQHC Look-Alikes in 1991 has grown to 122 Look- Alikes operating in 2007. As a key primary care resource, FQHC Look-Alikes have also successfully competed for section 330 grants due to their increased experience in meeting section 330 program requirements. From 2002 to 2007 there were 286 applications for New Access Point funding from FQHC Look-Alikes; 36 percent were successful in obtaining New Access Point awards during the 5-year period. HRSA anticipates that the number of FQHC Look-Alikes will vary each year based on demand for service and availability of Federal funds.

Figure 5. Number of FQHC Look-Alikes, 2002-2007

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Strengthening Existing Health Care Homes: Expanded Medical Capacity

Supporting the expansion of medical capacity at existing health center sites allows grantees to significantly increase the number of people with access to comprehensive primary and preventive health care services. Strategies may include but are not limited to expanding existing primary care medical services, adding new medical providers, expanding hours of operations, or providing additional medical services through contractual relationships (e.g., obstetric/gynecological services). Applicants for expanded medical capacity funds must ensure that the proposal will increase access to comprehensive primary and preventive health care and improve the health status of underserved and vulnerable populations. Further, applicants must address the major health care needs of the target population and ensure the availability and accessibility of essential primary and preventive health services to all individuals in the service area.

Expanding Existing Health Care Homes: Service Expansion

Mental health/substance abuse, oral health and comprehensive pharmacy services are critical to improving the health status of communities and patients served by health centers and eliminating disparities in access to health care. Applicants for service expansion funding are expected to describe the target population and its need for mental health/substance abuse services, oral health, and comprehensive pharmacy services and present a service delivery plan that demonstrates responsiveness to the identified needs of the target population.

Table 9. Trends in Health Center Program Funding by Type, 2002-2007

*Includes High Poverty New Access Point awards.

Source: U.S. Department of Health and Human Services, Health Resources and Services Administration. Rockville, Maryland: HRSA Electronic Handbooks (EHB) Grants Data, 2002-2007.

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