In the Midst of a Pandemic, Millions of Patients Risk Loss of Access to Community Health Centers

September 8, 2020

WASHINGTON, DC and NEW YORK, NY (Sept. 10, 2020) – In 2019, on the eve of the worst pandemic in a century, over 30 million patients received care at a community health center. Of these, the vast majority – 29.8 million (1 in 11 people in the U.S.) – depended on one of the nation’s 1,385 federally-funded community health centers.

These findings are presented in a new study from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (Milken Institute SPH). They underscore the steady growth of community health centers and highlight the importance of the Community Health Center Fund and the Affordable Care Act’s (ACA’s) Medicaid expansion.

The report, issued as part of the Collaborative’s signature policy brief series with the RCHN Community Health Foundation, examines health centers and their growth during 2019 and analyzes newly-released data from the U.S. Department of Health and Human Services Uniform Data System, an annual reporting system offering in-depth information about community health centers.

In 2019, the total number of patients served by community health centers (CHCs), including both federally-funded CHCs as well as those that receive core operational support from state and local governments (“look-alike” health centers), surpassed 30 million. From 2000 to 2019, the number of Medicaid patients served by federally-funded community health centers increased by 341 percent, a key indicator of the impact of the ACA Medicaid expansion on access to health insurance among the poorest Americans. The report further found key differences between Medicaid expansion and non-expansion states. In expansion states, the proportion of Medicaid-insured patients grew from 41 percent to 53 percent between 2010 and 2019; by contrast, in non-expansion states, the proportion grew from a much lower initial level of 31 percent to only 32 percent. In 2019, moreover, the proportion of uninsured patients served by health centers in non-expansion states was twice as high (36 percent) as in Medicaid expansion states (18 percent).  The additional revenue in Medicaid expansion states means that community health centers in these states are substantially larger and better staffed and offer a broader range of services. 

The 2019 data provide a snapshot of community health centers before the beginning of the worst pandemic in a century. Community health centers serve patients whose demographic and socioeconomic characteristics, coupled with chronic health conditions, significantly increase their risk of COVID-19 infection and poor outcomes. In 2019, nearly all patients (91 percent) were low-income, about two in three (63 percent) were members of racial and ethnic minority groups, and 10 percent were elderly. Among adult health center patients, 28 percent had hypertension and 15 percent had diabetes.

Nearly all (97 percent) community health centers currently provide COVID-19 diagnostic testing, but they have been severely impacted by the pandemic. Nearly 1 in 14 sites is closed, and visits have dropped by 20 percent compared to before the pandemic. The report estimates that between April and August 2020, community health centers lost a total of nearly $2.9 billion nationally, accounting for nine percent of total revenue reported in 2019. Emergency payments for COVID-19 testing and treatment have provided limited relief, but revenue losses can quickly be expected to exceed whatever short-term relief has been provided.  The Community Health Center Fund, which accounts for over 70 percent of all ongoing federal grant funding, is set to expire at the end of November and has yet to be extended. 

“The pandemic has intensified the need for community health centers, which provide care in the nation’s most at-risk communities” said Jessica Sharac, PhD, MSc, MPH, research scientist at Milken Institute SPH, and lead author of the latest analysis.

“Given their deep local roots and longstanding record of service, it is not surprising that community health centers have emerged as an indispensable resource in fighting the pandemic, but both short-term relief and secure, long-term funding are essential if health centers are 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. “Keeping our at-risk communities healthy means supporting the health center organizations on the front lines.”

The policy issue brief, “Community Health Centers on the Eve of the COVID-19 Pandemic: An Overview of Findings from the 2019 Uniform Data System” can be accessed here.


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.