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The Community Health Center Fund: In Brief

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The Community Health Center Fund: In Brief Elayne J. Heisler Specialist in Health Services February 12April 24, 2015 Congressional Research Service 7-5700 www.crs.gov R43911 The Community Health Center Fund: In Brief Contents Background ...................................................................................................................................... 1 CHCF as a Percentage of Health Center Funding ........................................................................... 2 CHCF Grants Awarded .................................................................................................................... 2 Figures Figure 1. The CHCF and Health Center Funding ............................................................................ 2 Tables Table 1. CHCF-Supported Grant Programs ..................................................................................... 3 Table 2. CHCF Funds Awarded, by State and Territory................................................................... 4 Contacts Author Contact Information............................................................................................................. 6 Acknowledgments ........................................................................................................................... 6 Congressional Research Service The Community Health Center Fund: In Brief Background The Health Center Program, which is administered by the Health Resources and Services Administration within the Department of Health and Human Services, awards grants to outpatient health care facilities that provide care to medically underserved populations.1 The program’s annual funding has more than doubled between FY2002 and FY2015, increasing from $1.3 billion to $4.9 billion. This funding increase—a result of both increases in annual discretionary appropriations and supplemental funding2—has resulted in more health centers, more patients seen and more services available to these patients.3 The program’s funding increase is due, in part, to the Community Health Center Fund (CHCF),4 a mandatory multibillion dollar fund established in the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended). This fund is available between FY2011 and FY2015FY2017. It was intended to increase health center appropriations above the level the program received in FY2008;5 however, the CHCF has partially supplanted annual appropriations since it began. The CHCF also supports the National Health Service Corps, a scholarship and loan repayment program that places providers in underserved areas including at health centers. Since FY2012, the CHCF has been that program’s sole funding source.6 CHCF funds have been used for a range of health center activities including funding new health centers, increasing services provided at existing health centers, and implementing care coordination initiatives.7 The CHCF represents more than 70% of the Health Center Program’s FY2015 funding and is set to expire at the end of the current fiscal year. For funding to continue at its current level, Congress would need to either extend the CHCF or appropriate additional discretionary funds.8 This report provides information on the CHCF that may be useful for discussions about the fund’s future. Specifically, it includes information on:. Funding for the CHCF was recently extended in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10), which provided $3.6 billion to support health center operations in each of FY2016 and FY2017 (a total of $7.2 billion). This report provides information on the CHCF. Specifically, it includes information on the types of grants awarded, total funds disbursed, and the amount of CHCF funds that facilitiescenters in each state and territory received. 1 For more information on health centers, see CRS Report R42433R43937, Federal Health Centers: An Overview. Annual discretionary appropriations during this time period and the American Recovery and Reinvestment Act (P.L. 111-5) provided supplemental funding in FY2009 and FY2010. See Table 3 in CRS Report R42433R43937, Federal Health Centers: An Overview, and CRS Report R40181, Selected Health Funding in the American Recovery and Reinvestment Act of 2009. 3 Peter Shin et al., Community Health Centers: A 2012 Profile and Spotlight on Implications of State Medicaid Expansion Decisions, The Kaiser Commission on Medicaid and the Uninsured, Issue Brief, Washington, DC, September 2014. 4 Section 10503 of the Patient Protection and Affordable Care Act (ACA) established the CHCF. Though the fund is named for community health centers (the most common type of health center), its funds are available for use by all four types of health centers: (1) community health centers, (2) health centers for the homeless, (3) migrant health centers, and (4) health centers for residents of public housing. 5 The FY2008 appropriation was $2.1 billion; see Table 3 in CRS Report R42433R43937, Federal Health Centers: An Overview. 6 CRS Report IN10185, Congress Faces Calls to Address Expiring ACA Funds for Primary Care. 7 See Table 1. 8 CRS Report IN10185, Congress Faces Calls to Address Expiring ACA Funds for Primary CareR43920, National Health Service Corps: Changes in Funding and Impact on Recruitment. 7 See Table 1. 2 Congressional Research Service 1 The Community Health Center Fund: In Brief CHCF as a Percentage of Health Center Funding The CHCF as a total percentage of federal funding for health centers has increased from 40% to 72% from FY2011 through F2015 (see Figure 1). Figure 1. The CHCF and Health Center Funding Source: CRS analysis of HRSA’s Congressional Budget Justifications. CHCF Grants Awarded ACA’s language creating the CHCF specified rather broad purposes—that the fund be used to “provide for expanded and sustained national investment in community health centers.”98 CHCF funds have been used to support operating grants at existing health centers and to support a number of specific grant programs (see Table 1).10 99 8 ACA Section 10503(a). The ACA also provided, for use between FY2011 and FY2015, $1 billion dollars to be used for health center construction and renovation. Grant awards from this program were made in FY2011 and FY2012 and supported 398 projects at 190 centers; see CRS Report R42433, Federal Health Centers. 109 Congressional Research Service 2 The Community Health Center Fund: In Brief Table 1. CHCF-Supported Grant Programs Name Description Funds Awarded New Access Points Grants to support new health center sites. $28.8 million (FY2011); $128.6 million (FY2012); $19 million (FY2013); $150 million (FY2014); $100 million (FY2015, expected) Expanded Services Grants for hiring new staff to extend hours and expand care that a health center provides. $295 million (FY2014) Health Center Outreach and Enrollment Assistance Grants to hire staff for in-person enrollment and eligibility assistance to uninsured individuals. $150 million (FY2013); $58 million (FY2014) Behavioral Health Integration Grants to expand behavioral health services by increasing the number of providers and services offered. $54.6 million (FY2014); $51.3 million (FY2015) Patient-Centered Medical Homes (PCMH) Grants to assist facilities with meeting the requirements to be certified as a PCMH. $32 million (FY2011); $44 million (FY2012) Quality Improvement/ Base Adjustment Adjustments to health center base funding for ongoing operations and quality improvement activities. $48 million (FY2013) PCMH Facility Improvement Grants for PCMH construction and facility renovations. $35.7 million (FY2014) Health Center Controlled Network- Health Information Technology (HIT) Grants to expand the use of advanced HIT. $21 million (FY2013) State and Regional Primary Care Association Cooperative agreements with state and regional organizations to provide health center training and technical assistance. $5.2 million (FY2011); $6.4 million (FY2013) HIV Service Integration Grants to support HIV services with primary care service integration. $5 million (FY2012); $6.2 million (FY2014) Planning and Development Grants to support organizations to plan and become health centers. $10 million (FY2011) Beacon Community Supplemental Funding Grants to support health center HIT adoption so as to improve health outcomes, improve care quality, and achieve cost efficiencies. $8.4 million (FY2011) Training and Technical Assistance Cooperative agreements to provide technical assistance to organizations that support health centers. $2.8 million (FY2011) Sources: CRS analysis of data from the HRSA data warehouse; CRS communication with HRSA’s Office of Legislation, January 5, 2015; and HRSA and HHS press releases obtained by searching http://www.hrsa.gov and http://www.hhs.gov/news/. CHCF funds were awarded from FY2011 through FY2015 to facilities and organizations in each of the 50 states, the District of Columbia, and the territories (see Table 2). Congressional Research Service 3 The Community Health Center Fund: In Brief Table 2. CHCF Funds Awarded, by State and Territory (Dollars in Thousands) State FY2011 FY2012 FY2013 FY2014 FY2015a Total Alaska $15,176 $16,651 $21,855 $31,370 $1,042 $86,094 Alabama $19,803 $23,584 $29,280 $39,000 $1,680 $113,347 Arkansas $11,603 $13,637 $16,951 $23,823 $66,014 $1,089 $901 $1,146 $1,899 $5,035 $18,945 $20,195 $24,729 $37,004 $2,100 $102,972 California $120,920 $140,404 $178,975 $275,331 $12,176 $727,806 Colorado $25,431 $29,531 $37,523 $45,921 $3,057 $141,464 Connecticut $12,973 $15,168 $18,923 $22,080 District of Columbia $4,644 $5,147 $5,731 $8,542 Delaware $3,290 $4,372 $6,164 $6,280 $48,926 $59,567 $73,248 $117,934 $423 $438 $476 $1,123 $21,263 $26,182 $37,181 $47,576 Guam $501 $519 $683 $1,059 Hawaii $6,879 $6,795 $8,606 $13,448 $1,048 $36,777 Iowa $8,507 $9,537 $12,555 $16,899 $378 $47,875 Idaho $9,026 $10,223 $13,255 $18,743 $889 $52,137 Illinois $41,748 $50,684 $64,450 $88,207 $1,365 $246,454 Indiana $12,420 $13,695 $17,216 $28,441 $1,707 $73,479 Kansas $7,397 $9,633 $13,030 $18,278 $1,167 $49,504 Kentucky $13,683 $17,800 $21,803 $31,162 $406 $84,854 Louisiana $17,792 $19,316 $24,680 $43,095 $2,742 $107,625 Massachusetts $24,757 $26,155 $32,222 $54,646 $2,577 $140,358 Maryland $13,633 $13,585 $16,069 $27,776 $1,701 $72,765 $8,751 $9,965 $11,100 $17,724 $1,744 $49,283 $295 $306 $338 $704 $23,757 $27,282 $33,868 $55,030 $3,745 $143,681 $8,829 $10,938 $13,775 $18,646 $547 $52,736 $20,092 $22,840 $28,811 $45,233 $794 $117,770 $608 $732 $738 $18,919 $19,150 $23,681 $34,055 $149 $95,953 $8,669 $10,250 $13,772 $18,292 $64 $51,046 $26,443 $31,974 $42,027 $57,132 $948 $158,522 American Samoa Arizona Florida Federated States of Micronesia Georgia Maine Marshall Islands Michigan Minnesota Missouri Northern Mariana Islands Mississippi Montana North Carolina Congressional Research Service $69,144 $128 $24,192 $20,106 $4,873 $304,549 $2,459 $1,901 $134,102 $2,762 $1,643 $2,078 4 The Community Health Center Fund: In Brief State FY2011 FY2012 FY2013 FY2014 FY2015a Total North Dakota $1,902 $1,818 $2,447 $4,211 $580 $10,959 Nebraska $3,830 $4,891 $6,211 $9,385 $59 $24,376 New Hampshire $4,280 $4,927 $7,334 $10,909 $557 $28,006 New Jersey $18,029 $18,509 $25,263 $37,524 $1,253 $100,578 New Mexico $17,132 $19,064 $25,423 $32,981 $877 $95,476 $3,963 $3,802 $7,030 $6,265 $562 $21,622 New York $54,430 $69,550 $84,280 $114,257 $5,420 $327,937 Ohio $27,229 $32,877 $37,969 $60,811 $2,820 $161,706 Oklahoma $12,270 $15,626 $19,901 $22,992 $1,507 $72,296 Oregon $18,770 $23,679 $29,405 $41,563 $1,515 $114,932 $358 $371 $292 $577 Pennsylvania $27,426 $31,807 $40,399 $55,918 $2,230 $157,779 Puerto Rico $19,894 $24,701 $30,063 $38,782 $265 $113,706 Rhode Island $7,259 $6,713 $7,671 $11,673 $1,043 $34,360 South Carolina $20,082 $23,988 $31,938 $37,320 $113 $113,441 South Dakota $4,150 $4,523 $5,597 $8,434 Tennessee $17,968 $21,473 $26,127 $36,560 $3,515 $105,643 Texas $60,559 $68,428 $86,323 $121,729 $5,110 $342,149 Utah $6,805 $6,834 $10,814 $16,712 $1,250 $42,414 $19,176 $22,143 $27,601 $38,361 $2,295 $109,576 $673 $789 $959 $1,339 $3,791 $4,126 $5,439 $10,222 $59 $23,636 $27,932 $30,811 $40,902 $57,496 $4,004 $161,145 $8,326 $11,069 $13,051 $18,617 $1,247 $52,311 $13,499 $15,001 $20,198 $29,218 $640 $78,556 $1,730 $1,921 $2,386 $3,999 $475 $10,512 $978,047 $1,136,477 $1,439,875 $2,075,045 $86,321,866 $5,716,765 $1,000,000 $1,200,000 $1,465,000c $2,145,000c $3,509,000c $9,319,000 Nevada Palau Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Totalb CHCF Allocation $1,597 $22,705 $3,761 Source: CRS communication with HRSA’s Office of Legislation, January 5, 2015. Notes: Blank cells indicate that no funds were received by that state or territory in that year. a. Data available as of January 5, 2015. Blank cells indicate that no funds were awarded to health centers in that state as of January 5, 2015. This report will be updated throughout FY2015 to reflect additional grants awarded to facilities in each state. b. Total indicates amount of grants awarded; it is lower than the amount appropriated to the CHCF as some funds are used by HRSA to administer these grant programs. c. The FY2013, FY2014, and FY2015 amounts were reduced by the sequester required under the Budget Control Act (P.L. 112-25). For more information, see CRS Report R42433R43937, Federal Health Centers: An Overview. Congressional Research Service 5 The Community Health Center Fund: In Brief Author Contact Information Elayne J. Heisler Specialist in Health Services eheisler@crs.loc.gov, 7-4453 Acknowledgments LaTiesha Cooper, Research Assistant, prepared the tables and figures included in this report. Congressional Research Service 6