The importance of federally qualified health centers and the Affordable Care Act

About six months after the Affordable Care Act (ACA) was passed in 2010, our Center hosted a symposium in Ann Arbor on the future of the health care safety net.  Sara Rosenbaum, an expert on both the ACA and federally qualified health centers (FQHCs), spoke at the event and her remarks emphasized that the ACA was designed to have FQHCs as a centerpiece.  Her viewpoint was a surprise to many who had not focused on the centrality of the connection between FQHCs and the ACA.  But, as we now head into the launch of the major coverage expansions included in the ACA, it is clearer how important FQHCs have become in the fabric of the health care delivery system.

FQHCs were started in 1964 as part of Lyndon Johnson’s Great Society program  (a term he coined at the University of Michigan). FQHCs were founded within the Office of Economic Opportunity (OEO) and known initially as Neighborhood Health Centers. Though the OEO was eliminated in the 1970s, Neighborhood Health Centers flourished and changed to become what we know today as FQHCs.

There are more than 1,100 FQHCs nationally and 30 in Michigan today.  And, they serve a significant percentage of the population.  In 2011, more than 546,000 people in Michigan got care from an FQHC.  While the vast majority of those were either uninsured or Medicaid recipients, more than 20 percent of those who received care at FQHCs had private coverage or Medicare—coverage that offers a good choice of providers located in other settings as well.

Between 2007 and 2011, the numbers of patients seeking care at FQHCs in Michigan increased by 22 percent while the number of visits increased by almost 27 percent.  Our own Cover Michigan Survey also noted this growth in clinics as a source of care for many Michigan patients. And, FQHCs have been expanding to meet the increased demand for care.

While most of the care delivered by FQHCs is basic medical care, the fastest growing area of care is mental health. Mental health practitioners are in short supply in many areas in our state and FQHCs’ ability to deliver this kind of care makes them a crucial service site in Michigan.

It looks, at last, like Michigan will indeed be expanding access to Medicaid. Assuming that the federal government approves at least the first waiver that will be requested by the state of Michigan, thousands of Michigan residents will soon move from being uninsured to having Medicaid coverage.  Many others will go from being uninsured to having private coverage with the help of tax credits.   Many of these individuals are already getting their care from FQHCs.  So, little change in their location of care may result from these big coverage expansions.  What will result, however, is an even further embedding of FQHCs in the mainstream of health care delivery.

While it may be debatable that the ACA intended FQHCs to be as central to the care delivery system as Sara Rosenbaum asserted, a variety of trends do seem to be converging to increase the importance of FQHCs in the delivery of medical care in our state and nationally. And, that fact may mean that integrated, coordinated medical care will get a boost as well. After all, FQHCs were among the first set of providers who saw themselves as a “patient centered medical home” – responsible for all aspects of a patient’s medical care. Having a provider who considers that kind of integrated care to be core to its mission is a great thing. So, intended or not, the ACA may accelerate a trend that already exists as more and more Michigan citizens turn to FQHCs for high quality and accessible medical care.

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Thu, 09/12/2013 - 2:00pm
I am an ignorant voter. Why does Michigan have to vote for Medicaid expansion to cover an additional 400-500 thousand people? Why are not these people covered already on Medicaid? What are the restrictions blocking their coverage? Why is mental health not covered also?
Jean Rishel
Thu, 09/12/2013 - 7:49pm
Neil, That 400,000 to 500,000 people who are now being covered earned too much to qualify for Medicaid before. "Program Description The Michigan Medicaid Health Care Program is intended to provide medical and health-related assistance to low-income individuals and families who have no medical insurance or have inadequate medical insurance. Generally, the program serves: persons aged 65 or older; blind or permanently disabled persons; members of families with dependent children; children in foster care homes; pregnant women; and individuals under age 21 in psychiatric hospitals. General Program Requirements In order to qualify for this benefit program, you must be a resident of the state of Michigan, a U.S. national, citizen or permanent resident in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. If very low income, you must also be pregnant, have a child(ren) with a disability, or be responsible for children under the age of 19 years." Before the Affordable Care Act, you were not allowed to have over $2000 in total assets if single, and $3000 in total assets for a couple. Plus, the income limits were based on the Federal Poverty Levels: for a family of four is $23,550 in 2013/ and $11, 490 for a single individual. Under the current program, before the ACA kicks in you were not eligible, as a single person, unless you had children, or had some sort of disability. The AFA opens up Medicaid to nearly everyone who is earning up to 133% of the Federal Poverty Level...and this is where the extra people come from with new coverage. You often did not qualify before, unless you had children. Everyone now qualifies, if you are a citizen of this country and meet the eligibility of 133% of the Federal Poverty Level income.
Fri, 09/13/2013 - 12:27pm
Jean: Your comparison of health care pre-ACA vs. pending-ACA could not be more "on spot". With the eligibility of 133% of the FPL income, many more individuals will now become a part of an ever-growing population of individuals without medical (or inadequate medical) insurance coverage.
Fri, 09/13/2013 - 10:08pm
These programs enable obamacare. These programs shuffled $$ from medicare to Medicaid..... this is the redistribution method that the current president is using to promote socialism which eventually becomes communism. The goal of these programs is to have everyone covered which is impossible. It doesn't address illegals, criminals etc. and how is that going to afford coverage. When the government hands out freebies , hard working retirees and workers pay for the lazy. Apparently no one has read the health bill which is nothing but a tax policy, not a health policy.