Community Health Centers in a Maturing Market; Continued Patient and Service Expansion in 2017

WASHINGTON, DC and NEW YORK, NY (September 5, 2018) – The nation’s community health centers play an increasingly visible role in the maturing, post-Affordable Care Act (ACA) market and continue to show major growth, according to two new studies issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health.

The first report, published in partnership with the Kaiser Family Foundation, documents health center performance on multiple key measures based on a national survey conducted in early 2018. That report, Community Health Centers' Experiences in a More Mature ACA Market,

examines health centers’ outreach and enrollment activities, including their efforts to adjust to the shorter open enrollment period in effect in most states and the extensive enrollment assistance they continue to furnish, even as one-third of navigator funding recipients reported experiencing reduced navigator funding for 2017-2018. The report examines growth in health center services and capacity in the past calendar year, with the most commonly reported increases reported for mental health services and staff, substance use disorder treatment services and staff, chronic care management services, and dental services and staff.  Even as the percentage of insured patients has continued to grow, more than half of surveyed health centers reported an increase in the past calendar year in insured patients unable to afford cost-sharing and deductibles.

The second report, released as part of the Collaborative’s signature policy brief series with the RCHN Community Health Foundation, examines health centers’ continued growth during 2017.  That year, health centers served nearly 28 million patients. The report is based on newly released data from the U.S. Department of Health and Human Services Uniform Data System, an ongoing annual reporting system offering in-depth information about community health centers.  

The report documents a five percent growth in patients served between 2016 and 2017 and a near-tripling of the number of patients served between 2000 and 2017. Between 2010 and 2017, the number of Medicaid and privately insured patients served increased by 78 percent and 77 percent, respectively.  Health centers serve one in every five uninsured people and, while the proportion of uninsured patients has steadily declined as a result of the ACA, health centers continue to treat large numbers of patients without health insurance – 6.2 million in 2017.

The 2017 analysis also examines the role played by health centers in caring for the elderly. Between 2010 and 2017, the number of elderly adults served grew by 77 percent, outpacing overall patient growth (40 percent) during the same time period. Correspondingly, the number of Medicare beneficiaries grew by 75 percent in that time period.

While most patients use health centers for medical care, dental care accounted for one in 7 visits during 2017.  Mental health also has emerged as a crucial health center service.  In 2017, more than 80 percent of health centers furnished dental care and nearly 90 percent provided mental health care. As the percentage of community health centers offering substance use disorder services has increased – from 20 percent of all health centers in 2010 to 35 percent in 2017 – medication assisted treatment has emerged as an increasingly common service. In 2017, health centers reported providing medication-assisted treatment to nearly 65,000 patients with opioid use disorder.

The ACA adult Medicaid expansion continues to be associated with far more robust growth; health centers in expansion states show substantially greater patient care capacity. By contrast, health centers in non-expansion states remain more reliant on grant funding. However, in both expansion and non-expansion states, grants continue to offer crucial support for costs associated with uninsured patients, clinical care for which no insurance coverage is provided, and the cost of enabling services that help patients get the care they need.   

“Community health centers have emerged as an indispensable part of the health care system, providing ongoing, high-value care to many of the nation’s most vulnerable people. The studies show that both a strengthened grant program and insurance expansion are essential to maintain growth in capacity and services,” said Feygele Jacobs, DrPH, President and CEO of the RCHN Community Health Foundation, whose ongoing gift supports the Geiger Gibson Program.  

The policy issue brief, “Community Health Centers Continued to Expand Patient and Service Capacity in 2017” can be accessed here.

The survey report, Community Health Centers’ Experiences in a More Mature ACA Market, can be accessed here.

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The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at The George Washington University.

The RCHN Community Health Foundation is the only foundation in the U.S. dedicated solely to community health centers. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship.

The Milken Institute School of Public Health at the George Washington University is the only school of public health in the nation’s capital.