[1][2] During the 1980s, local health centers faced challenges in securing reimbursements from Medicare and Medicaid due to restrictive state payment rates and eligibility criteria, limiting their financial resources.
A major turning point came at the end of the decade with the creation of the Federally Qualified Health Center designation, under the Omnibus Budget Reconciliation Act.
[4] FQHCs demonstrated notable success in delivering high-quality, cost-effective health care to vulnerable populations despite the challenges involved.
[1] The Affordable Care Act (ACA) significantly expanded FQHCs by allocating $11 billion through the Community Health Center Fund between 2011 and 2015, supporting the establishment and expansion of delivery sites.
[8][7] Before FQHCs were established in the 1980s, structural factors such as redlining-perpetuated segregation, contributing to ongoing inequities in healthcare access for communities that historically faced barriers and were excluded from quality, trustworthy medical services.
[9] FQHCs adhere to an "open door" policy, offering care regardless of patients' financial ability to pay, and predominantly serve low-income and uninsured individuals and Medicaid beneficiaries.
They also deliver diabetes self-management training, medical nutrition therapy, and preventive primary health services mandated by Section 330.
[2] FQHCs must comply with standards set by the HRSA, including governance, quality reporting, and operational criteria, and ensure accessibility through a sliding fee scale based on patients' income.
According to the HRSA, MUAs are characterized by a shortage of primary care providers, elevated infant mortality rates, high poverty levels, or a significant elderly population.
"This structure, inspired by the participatory democracy ethos of the Civil Rights Movement and a strong sentiment of "antiprofessionalism" aimed at empowering the poor, seeks to make FQHCs more attuned to community needs by amplifying the voices of underrepresented patients.
[15] Medicaid is the largest revenue source for FQHCs, but Medicare offers financial incentives, such as higher per-visit fees compared to non-FQHC providers, making FQHC status attractive.
[3] Billions of federal dollars have been allocated through the Affordable Care Act's Community Health Center Fund and the American Rescue Plan to establish, expand, and sustain FQHCs nationwide.
[9] Health programs funded include:[16] Throughout the United States, FQHCs are strategically located in high-poverty and/or medically underserved areas, frequently serving as the sole source of care for the communities they support.
They are situated primarily in areas limited health care access, and elevated rates of chronic conditions like diabetes, hypertension, and obesity.
Serving undocumented and uninsured minorities, who represent a significant portion of their patient base and are excluded from many health care reforms, further strains their capacity.
The lack of on-site specialty services, such as Pap tests, mammography, or colonoscopy referrals, creates barriers for patients, particularly Spanish-speaking individuals.
Having Spanish-speaking staff and educational materials, along with on-site services, helps overcome communication challenges and improve access to care.
Outdated underserved designation and a bureaucratically burdensome process of being certified and being financially supported by federal grants are two fundamental factors that could directly affect FQHC expansion to new areas.
For example, Johns Hopkins Medicine implemented an AMC-FQHC collaboration in East Baltimore, which resulted in increased staffing, new wraparound services, improved funding access, and decreased out-of-pocket costs for eligible patients.
[5] They have been instrumental in expanding access to health care for medically underserved and rural areas, low-income groups, and racial and ethnic minorities.
[2] FQHCs are particularly effective in managing ambulatory care-sensitive conditions and providing preventive care, resulting in fewer emergency department visits and hospitalizations among their patients.
[8] FQHCs provide Medicare beneficiaries with preventive primary health services such as immunizations, visual acuity and hearing screenings, and prenatal and post-partum care.