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