Overview of the CHC Model

Federally Qualified Health Center (FQHC) is a federal designation from the Health Resources Services Administration, Bureau of Primary Health Care (BPHC) that is assigned to private non-profit or public health care organizations that serve predominantly uninsured or medically underserved populations. FQHCs must be located in or serve a federally designated Medically Underserved Area/Population (MUA or MUP).  All FQHCs must operate under a patient majority Board of Directors governance structure, and provide comprehensive primary and preventive medical, dental, and mental health/substance abuse services to persons in all stages of the life cycle. FQHCs provide their services to all payor types including Medicaid, Medicare, private insurance, and uninsured based on a Board approved sliding-fee scale that is based on patients’ family income, size and federal poverty level. FQHCs must comply with Section 330 program expectations/requirements and all applicable federal and state regulations.

What are the Benefits of FQHC Status for a Community and an Organization Considering Such a Development?

The direct benefits to the community include:

  • Community-based organization whereby the community and patients of the health center help govern and determine the needed services and help determine other decisions related to the health center operations,
  • Medical / health care home for residents that provides comprehensive health services to the medically underserved so non-emergent cases in hospital emergency rooms will be reduced,
  • Increased economic impact of federal and state investments for services and potential for future federal investment,
  • Reduction in the number of uninsured due to FQHC assistance with Medicaid and Children's Health Insurance Program enrollment,
  • Less financial strain on Medicare patients due to deductible waiver if services are provided at a Community Health Center ,
  • Referral arrangements for FQHC patients provide better access to other health providers.
  • Community Health Centers help children stay healthy so they can stay in school and learn. CHCs help adults stay healthy, providing the community with a healthy workforce. A healthy workforce produces a healthy community. Healthy communities are economic engines spurring growth and change that benefits everyone.

The direct benefits to the organization considering FQHC development include:

  • Federal grant support to cover costs of uncompensated care
  • Reimbursement rates which are enhanced due to the Prospective Payment System reimbursement for services to Medicaid and Medicare patients
  • Medical malpractice coverage under Federal Tort Claims Act (FTCA)
  • PHS Drug Pricing Discounts for pharmaceutical products through the 340B program

Medicare reimbursement for “first dollar” of services because deductible is waived if FQHC is providing services, access to National Health Service Corps (NHSC) Placements to provide medical dental and mental health provider staff.