Expansion of primary care – community health centers


Health reform isn’t just about insurance reform.  If enacted, it is likely that health reform will provide a major boost to primary care health resources for underserved communities.

Federally qualified health centers (FQHCs) are locally-based community health centers designed to provide primary care to medically underserved areas and populations and to assure access to care for those of limited means.  Most of them are private, nonprofit corporations, although some are operated by local governments.

They provide a wide range of primary care, often including dental and mental health care.  They accept Medicare, Medicaid and private insurance, but they also charge an affordable sliding fee scale to those with no insurance or inadequate insurance.  States’ Medicaid programs are required to pay them a per-visit rate designed to cover the average cost of such a visit. (If a Medicaid managed care plan pays less than the required amount, the State must make up the difference.)

In order to assure that FQHCs are responsive to the local community, they are required to be governed by an active board a majority of whose members are patients of the center, and the board as a whole must be representative of populations served.  No more than half of the non-consumer members may derive more than 10% of their annual income from the health care industry.

FQHCs receive start-up and operating funds from grants under Section 330 of the Public Health Services Act – and here is where the new health reform legislation could have a substantial impact.   An eleventh-hour amendment to the Senate Bill by Senator Bernie Sanders (I-VT) would provide “enhanced funding” over the five fiscal years starting October 1, 2010 in the amounts of $7 billion for the community health center program, $1.5 billion for the National Health Service Corps, and another $1.5 billion for construction and renovation of community health centers.

Both bills expand the list of Medicare-covered services to be provided at FQHCs to include an initial preventive physical exam and a long list of screening and other preventive health services.

The Senate bill also requires health insurance plans in the new exchanges to pay for FQHC services at the same generous rate as the Medicaid program and would create a new Medicare payment system for these services.

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