The Community Health Center Fund: In Brief

January 7, 2016 (R43911)

Contents

Figures

Tables

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 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.

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."8 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

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)

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); $63 million (FY2015)

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 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)

State

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016a

Totalb

Alaska

$15,176

$16,651

$21,855

$31,370

$45,789

$3,069

$134,435

Alabama

$19,803

$23,584

$29,280

$39,000

$58,662

$4,813

$175,142

Arkansas

$11,603

$13,637

$16,951

$23,823

$37,286

$3,369

$106,734

American Samoa

$1,089

$901

$1,146

$1,899

$1,348

 

$6,383

Arizona

$18,945

$20,195

$24,729

$37,004

$52,156

$11,894

$164,994

California

$120,920

$140,404

$178,975

$275,331

$445,489

$45,281

$1,206,478

Colorado

$25,431

$29,531

$37,523

$45,921

$62,087

$12,865

$213,362

Connecticut

$12,973

$15,168

$18,923

$22,080

$35,906

$2,389

$107,439

District of Columbia

$4,644

$5,147

$5,731

$8,542

$18,315

$3,085

$48,672

Delaware

$3,290

$4,372

$6,164

$6,280

$7,459

$927

$28,491

Florida

$48,926

$59,567

$73,248

$117,934

$165,216

$15,731

$480,837

Federated States of Micronesia

$423

$438

$476

$1,123

$1,804

$524

$4,787

Georgia

$21,263

$26,182

$37,181

$47,576

$73,665

$4,646

$210,587

Guam

$501

$519

$683

$1,059

$1,460

 

$4,222

Hawaii

$6,879

$6,795

$8,606

$13,448

$21,135

$656

$57,521

Iowa

$8,507

$9,537

$12,555

$16,899

$27,913

$571

$75,982

Idaho

$9,026

$10,223

$13,255

$18,743

$32,664

$882

$84,797

Illinois

$41,748

$50,684

$64,450

$88,207

$132,420

$10,973

$388,537

Indiana

$12,420

$13,695

$17,216

$28,441

$48,338

$5,539

$125,699

Kansas

$7,397

$9,633

$13,030

$18,278

$28,237

$1,937

$78,528

Kentucky

$13,683

$17,800

$21,803

$31,162

$49,239

$3,684

$137,392

Louisiana

$17,792

$19,316

$24,680

$43,095

$66,806

$4,362

$176,054

Massachusetts

$24,757

$26,155

$32,222

$54,646

$81,352

$1,957

$221,090

Maryland

$13,633

$13,585

$16,069

$27,776

$33,994

$5,644

$107,495

Maine

$8,751

$9,965

$11,100

$17,724

$30,754

$2,984

$81,276

Marshall Islands

$295

$306

$338

$704

$785

 

$2,428

Michigan

$23,757

$27,282

$33,868

$55,030

$89,391

$4,597

$233,945

Minnesota

$8,829

$10,938

$13,775

$18,646

$28,149

$1,403

$81,741

Missouri

$20,092

$22,840

$28,811

$45,233

$68,824

$2,263

$188,067

Northern Mariana Islands

$608

$732

$738

$906

 

$2,984

Mississippi

$18,919

$19,150

$23,681

$34,055

$49,672

$3,539

$149,090

Montana

$8,669

$10,250

$13,772

$18,292

$27,698

$170

$78,850

North Carolina

$26,443

$31,974

$42,027

$57,132

$95,453

$8,243

$261,271

North Dakota

$1,902

$1,818

$2,447

$4,211

$7,262

$694

$18,421

Nebraska

$3,830

$4,891

$6,211

$9,385

$12,291

 

$36,608

New Hampshire

$4,280

$4,927

$7,334

$10,909

$16,817

$762

$45,034

New Jersey

$18,029

$18,509

$25,263

$37,524

$53,364

$6,264

$158,984

New Mexico

$17,132

$19,064

$25,423

$32,981

$43,138

$5,853

$143,591

Nevada

$3,963

$3,802

$7,030

$6,265

$11,065

$430

$32,555

New York

$54,430

$69,550

$84,280

$114,257

$177,345

$22,954

$523,136

Ohio

$27,229

$32,877

$37,969

$60,811

$100,662

$15,122

$274,676

Oklahoma

$12,270

$15,626

$19,901

$22,992

$39,075

$1,420

$111,284

Oregon

$18,770

$23,679

$29,405

$41,563

$45,789

$3,069

$179,799

Palau

$358

$371

$292

$577

$811

$269

$2,678

Pennsylvania

$27,426

$31,807

$40,399

$55,918

$86,292

$3,209

$245,050

Puerto Rico

$19,894

$24,701

$30,063

$38,782

$56,486

$4,282

$174,209

Rhode Island

$7,259

$6,713

$7,671

$11,673

$20,470

$3,107

$56,894

South Carolina

$20,082

$23,988

$31,938

$37,320

$49,574

$1,435

$164,338

South Dakota

$4,150

$4,523

$5,597

$8,434

$12,625

$2,724

$38,054

Tennessee

$17,968

$21,473

$26,127

$36,560

$59,695

$3,042

$165,138

Texas

$60,559

$68,428

$86,323

$121,729

$184,926

$9,867

$531,948

Utah

$6,805

$6,834

$10,814

$16,712

$25,117

$2,711

$68,993

Virginia

$19,176

$22,143

$27,601

$38,361

$56,120

$6,730

$170,184

Virgin Islands

$673

$789

$959

$1,339

$2,368

 

$6,129

Vermont

$3,791

$4,126

$5,439

$10,222

$12,865

$1,899

$38,341

Washington

$27,932

$30,811

$40,902

$57,496

$94,593

$5,622

$257,356

Wisconsin

$8,326

$11,069

$13,051

$18,617

$32,303

$629

$83,997

West Virginia

$13,499

$15,001

$20,198

$29,218

$46,687

 

$124,603

Wyoming

$1,730

$1,921

$2,386

$3,999

$6,382

$59

$16,478

Totalb

$978,047

$1,136,477

$1,439,875

$2,075,045

$3,190,836

$271,334

$9,093,790

CHCF Allocation

$1,000,000

$1,200,000

$1,465,000d

$2,145,000d

$3,509,000

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

c. 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.

d. 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, Research Assistant, prepared the tables and figures included in this report.

Footnotes

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.

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