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The Community Health Center Fund: In Brief

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The Community Health Center Fund: In Brief

January 7, 201613, 2017 (R43911)

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 tripled between FY2002 and FY2016, increasing from $1.3 billion to $5.1 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 FY2017. 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 CHCF funds have also been used to fund health centers in need of immediate funding such as those in Flint, MI, which had immediate health service needs due to the discovery of lead in its water supply, and those in Puerto Rico and other territories, which had additional health service needs related to the Zika virus.8 The CHCF represents more than 70% of the Health Center Program's FY2016 funding. Funding for the CHCF was 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 centers in each state and territory received.

This report does not include FY2017 data because full-year appropriations have not been made as of this report's publication date. This report will be updated to reflect FY2017 appropriations.

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 F2016 (see Figure 1).

Figure 1. The CHCF and Health Center Funding

(Dollars in Millions)

Source: CRS analysis of HRSA's Congressional Budget Justifications; P.L. 114-10 and P.L. 114-113.

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."89 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).9

initiatives that seek to expand services and to improve the care provided by health centers (see Table 1).10

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); $270 million (FY2015)

Expanded Services

Grants for hiring new staff to extend hours and expand care that a health center provides.

$295 million (FY2014); $6.4 million (FY2015); $7 million (FY2016)

; $156 million (FY2016 for oral health)

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 (including facility-related requirements) to be certified as a PCMH.

$32 million (FY2011); $44 million (FY2012)

; $35.7 million (FY2014); $8.6 million (FY2016)

Quality Improvement/ Base Adjustment

Adjustments to health center base funding for ongoing operations and quality improvement activities.

$48 million (FY2013); $63 million (FY2015)

; $100 million (FY2016)

PCMH Facility Improvement

Grants for PCMH construction and facility renovationsrenovations to increase the number of patients served.

$35.7260 million (FY2014FY2016)

Health Center Controlled Network- Health Information Technology (HIT)

Grants to expand the use of advanced HIT.

$21 million (FY2013)

; $123 million (FY2016)

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)

Opioid and Heroin Treatment

Grants to expand substance abuse services at health centers.

$94 million (FY2016)

Sources: CRS analysis of data from the HRSA data warehouse; CRS communication with HRSA's Office of Legislation, January 5, 2015, and December 30, 2016; and HRSA and HHS press releases obtained by searching http://www.hrsa.gov and http://www.hhs.gov/news/.

FY2016 funds were also used to fund health centers in Flint, MI, and the territories for Zika virus related health services.

CHCF funds were awarded from FY2011 through FY2016 to facilities and organizations in each of the 50 states, the District of Columbia, and the territories (see Table 2).

Table 2. CHCF Funds Awarded, by State and Territory

(Dollars in Thousands)

$4,025

State

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016a

Totalb

a

Alaska

$15,176

$16,651

17,176

$21,855

$31,370

$45,789

$3,069

48,670

$134,435

180,037

Alabama

$19,803

$23,584

$29,280

$39,000

$58,662

$4,813

55,617

$175,142

225,946

Arkansas

$11,603

634

$13,637

671

$16,951

$23,823

$37,286

$3,369

34,559

$106,734

137,923

American Samoa

$1,089

$901

$1,146

$1,899

$1,348

  

$2,360

$6,383

8,743

Arizona

$18,945

19,016

$20,195

$24,729

$37,004

$52,156

$11,894

63,647

$164,994

216,747

California

$120,920

943

$140,404

459

$178,975

$275,331

$445,489

460

$45,281

494,221

$1,206,478

655,389

Colorado

$25,431

$29,531

535

$37,523

$45,921

$62,087

$12,865

72,845

$213,362

273,342

Connecticut

$12,973

$15,168

$18,923

$22,080

$35,906

$2,389

45,680

$107,439

150,730

District of Columbia

$4,644

5,211

$5,147

852

$5,731

6,465

$8,542

9,744

$18,315

$3,085

20,258

$48,672

65,845

Delaware

$3,290

$4,372

$6,164

$6,280

$7,459

$927

10,225

$28,491

37,790

Florida

$48,926

992

$59,567

$73,248

398

$117,934

$165,216

$15,731

170,243

$480,837

635,350

Federated States of Micronesia

$423

$438

$476

$1,123

$1,804

836

$524

2,136

$4,787

6,431

Georgia

$21,263

338

$26,182

$37,181

$47,576

$73,665

$4,646

83,684

$210,587

289,625

Guam

$501

$519

$683

$1,059

$1,460

  

$1,361

$4,222

5,583

Hawaii

$6,879

880

$6,795

$8,606

$13,448

$21,135

$656

23,212

$57,521

80,077

Iowa

$8,507

$9,537

$12,555

$16,899

$27,913

$571

28,002

$75,982

103,413

Idaho

$9,026

029

$10,223

$13,255

$18,743

$32,664

$882

33,182

$84,797

117,097

Illinois

$41,748

$50,684

739

$64,450

$88,207

$132,420

$10,973

144,843

$388,537

522,408

Indiana

$12,420

$13,695

746

$17,216

$28,441

$48,338

$5,539

58,643

$125,699

178,804

Kansas

$7,397

414

$9,633

$13,030

$18,278

$28,237

$1,937

34,513

$78,528

111,105

Kentucky

$13,683

705

$17,800

$21,803

$31,162

$49,239

267

$3,684

54,770

$137,392

188,508

Louisiana

$17,792

$19,316

320

$24,680

$43,095

$66,806

$4,362

74,742

$176,054

246,434

Massachusetts

$24,757

$26,155

$32,222

$54,646

$81,352

$1,957

95,352

$221,090

314,485

Maryland

$13,633

066

$13,585

12,880

$16,069

15,336

$27,776

26,574

$33,994

34,035

$5,644

40,760

$107,495

142,651

Maine

$8,751

$9,965

$11,100

$17,724

$30,754

805

$2,984

32,886

$81,276

111,231

Marshall Islands

$295

$306

$338

$704

$785

  

$808

$2,428

3,236

Michigan

$23,757

770

$27,282

289

$33,868

$55,030

$89,391

$4,597

97,298

$233,945

326,646

Minnesota

$8,829

$10,938

$13,775

$18,646

$28,149

$1,403

29,128

$81,741

109,466

Missouri

$20,092

096

$22,840

$28,811

$45,233

$68,824

839

$2,263

83,065

$268,884

$188,067

Northern Mariana Islands

$608

$732

$738

$906

  

$2,984

Mississippi

$18,919

939

$19,150

205

$23,681

$34,055

$49,672

$3,539

49,916

$149,090

195,467

Montana

$8,669

$10,250

$13,772

$18,292

$27,698

$170

29,685

$78,850

108,365

North Carolina

$26,443

$31,974

$42,027

$57,132

$95,453

$8,243

91,974

$261,271

345,002

North Dakota

$1,902

989

$1,818

$2,447

$4,211

$7,262

$694

7,445

$18,421

25,172

Nebraska

$3,830

$4,891

$6,211

$9,385

$12,291

  

$16,670

$36,608

53,278

New Hampshire

$4,280

$4,927

$7,334

340

$10,909

$16,817

$762

18,452

$45,034

62,724

New Jersey

$18,029

036

$18,509

534

$25,263

$37,524

$53,364

$6,264

62,578

$158,984

215,299

New Mexico

$17,132

$19,064

$25,423

$32,981

$43,138

$5,853

55,949

$143,591

193,687

Nevada

$3,963

$3,802

$7,030

$6,265

$11,065

$430

15,349

$32,555

47,474

New York

$54,430

434

$69,550

$84,280

597

$114,257

$177,345

$22,954

$523,136

512

$194,513

$694,862

Northern Mariana Islands

$608

$732

$738

$906

$1,041

Ohio

$27,229

236

$32,877

$37,969

$60,811

$100,662

$15,122

108,040

$274,676

367,595

Oklahoma

$12,270

$15,626

$19,901

$22,992

$39,075

$1,420

43,577

$111,284

153,441

Oregon

$18,770

$23,679

$29,405

$41,563

$45,789

62,124

$3,069

67,299

$179,799

242,840

Palau

$358

$371

31,807

$292

40,399

$577

55,918

$811

86,292

$269

89,,813

$2,678

331,654

Pennsylvania

$27,426

$31,807

24,701

$40,399

30,063

$55,918

38,782

$86,292

56,486

$3,209

67,430

$245,050

237,358

Puerto Rico

$19,894

$24,701

371

$30,063

292

$38,782

577

$56,486

811

$4,282

780

$174,209

3,189

Rhode Island

$7,259

$6,713

$7,671

$11,673

$20,470

$3,107

20,970

$56,894

74,757

South Carolina

$20,082

$23,988

$31,938

$37,320

$49,574

$1,435

60,102

$164,338

223,004

South Dakota

$4,150

$4,523

$5,597

$8,434

$12,625

$2,724

12,131

$38,054

47,461

Tennessee

$17,968

$21,473

$26,127

400

$36,560

$59,695

$3,042

62,397

$165,138

224,493

Texas

$60,559

674

$68,428

$86,323

$121,729

$ 184,926

$9,867

179,902

$531,948

701,982

Utah

$6,805

$6,834

$10,814

$16,712

$25,117

$2,711

29,516

$68,993

95,798

Virginia

$19,176

223

$22,143

149

$27,601

$38,361

$56,120

$6,730

64,809

$170,184

228,263

Virgin Islands

$673

$789

$959

$1,339

$2,368

  

$2,351

$6,129

8,480

Vermont

$3,791

$4,126

$5,439

$10,222

$12,865

$1,899

22,564

$38,341

59,006

Washington

$27,932

$30,811

$40,902

$57,496

$94,593

$5,622

95,990

$257,356

347,724

Wisconsin

$8,326

327

$11,069

$13,051

$18,617

$32,303

$629

35,536

$83,997

118,904

West Virginia

$13,499

$15,001

$20,198

$29,218

$46,687

  

$52,842

$124,603

177,445

Wyoming

$1,730

$1,921

$2,386

$3,999

$6,382

319

$59

6,038

$16,478

22,394

Totalb

a

$978,047

659

$1,136,477

137,296

$1,439,875

440,620

$2,075,045

$3,190,836

191,077

$271,334

3,502,371

$9,093,790

12,325,067

CHCF Allocationb

$1,000,000

$1,200,200,000

$1,465,000d

c

$2,145,000d

c

$3,509,000

,509,000c

$3,600,000

$12,919,000

Source: CRS analysis of HRSA's Datawarehouse (at http://www.hrsa.gov/data-statistics/index.html.

Notes: Blank cells indicate that no funds were received by that state or territory in that year.

a. Data available as of January 5, 2016. Blank cells indicate that no funds were awarded to health centers in that state as of January 5, 2016.

b) and of data obtained from HRSA, personal communication, December 28, 2016.

Notes: Blank cells indicate that no funds were received by that state or territory in that year.

a. Total indicates the cumulative amount a given state has received from the CHCF since the fund began in FY2011.

cb. 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.

dc. 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 R43937, Federal Health Centers: An Overview.

Author Contact Information

[author name scrubbed], Specialist in Health Services ([email address scrubbed], [phone number scrubbed])

Acknowledgments

LaTiesha Cooper, former CRS Research Assistant, prepared the tables and figures included in this report.

Footnotes

10ACA Section 10503(a).

1.

For more information on health centers, see CRS Report R43937, Federal Health Centers: An Overview.

2.

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 R43937, 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 R43937, Federal Health Centers: An Overview.
6.

CRS Report R43920, National Health Service Corps: Changes in Funding and Impact on Recruitment.
7.

See Table 1.

8.

U.S. Department of Health and Human Services, Health Resources and Services Administration, press releases, "HHS Awards $500,000 in Funding to Flint Health Centers," https://www.hhs.gov/about/news/2016/02/18/hhs-awards-500000-funding-flint-health-centers.html; "HHS Awards $ 5 Million to Puerto Rico Health Centers to Fight the Spread of Zika Virus," April 26, 2016, https://www.hhs.gov/about/news/2016/04/26/hhs-awards-5-million-to-puerto-rico-health-centers.html; and "HHS Awards More than $742,000 to Health Centers in American Samoa and the Virgin Islands to Fight Zika," June 23, 2016, https://www.hhs.gov/about/news/2016/06/23/hhs-awards-more-742000-health-centers-american-samoa-and-virgin-islands-fight-zika.html.

9.

ACA Section 10503(a).

9.

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.