The importance of federally qualified health centers and the Affordable Care Act

Marianne Udow-Phillips is the director of the Center for Healthcare Research & Transformation, a nonpartisan health policy center based at the University of Michigan with a mission to promote evidence-based care delivery, improve population health and expand access to care.

About six months after the Affordable Care Act (ACA) was passed in 2010, our Center hosted a symposium in Ann Arbor on the future of the health care safety net.  Sara Rosenbaum, an expert on both the ACA and federally qualified health centers (FQHCs), spoke at the event and her remarks emphasized that the ACA was designed to have FQHCs as a centerpiece.  Her viewpoint was a surprise to many who had not focused on the centrality of the connection between FQHCs and the ACA.  But, as we now head into the launch of the major coverage expansions included in the ACA, it is clearer how important FQHCs have become in the fabric of the health care delivery system.

FQHCs were started in 1964 as part of Lyndon Johnson’s Great Society program  (a term he coined at the University of Michigan). FQHCs were founded within the Office of Economic Opportunity (OEO) and known initially as Neighborhood Health Centers. Though the OEO was eliminated in the 1970s, Neighborhood Health Centers flourished and changed to become what we know today as FQHCs.

There are more than 1,100 FQHCs nationally and 30 in Michigan today.  And, they serve a significant percentage of the population.  In 2011, more than 546,000 people in Michigan got care from an FQHC.  While the vast majority of those were either uninsured or Medicaid recipients, more than 20 percent of those who received care at FQHCs had private coverage or Medicare—coverage that offers a good choice of providers located in other settings as well.

Between 2007 and 2011, the numbers of patients seeking care at FQHCs in Michigan increased by 22 percent while the number of visits increased by almost 27 percent.  Our own Cover Michigan Survey also noted this growth in clinics as a source of care for many Michigan patients. And, FQHCs have been expanding to meet the increased demand for care.

While most of the care delivered by FQHCs is basic medical care, the fastest growing area of care is mental health. Mental health practitioners are in short supply in many areas in our state and FQHCs’ ability to deliver this kind of care makes them a crucial service site in Michigan.

It looks, at last, like Michigan will indeed be expanding access to Medicaid. Assuming that the federal government approves at least the first waiver that will be requested by the state of Michigan, thousands of Michigan residents will soon move from being uninsured to having Medicaid coverage.  Many others will go from being uninsured to having private coverage with the help of tax credits.   Many of these individuals are already getting their care from FQHCs.  So, little change in their location of care may result from these big coverage expansions.  What will result, however, is an even further embedding of FQHCs in the mainstream of health care delivery.

While it may be debatable that the ACA intended FQHCs to be as central to the care delivery system as Sara Rosenbaum asserted, a variety of trends do seem to be converging to increase the importance of FQHCs in the delivery of medical care in our state and nationally. And, that fact may mean that integrated, coordinated medical care will get a boost as well. After all, FQHCs were among the first set of providers who saw themselves as a “patient centered medical home” – responsible for all aspects of a patient’s medical care. Having a provider who considers that kind of integrated care to be core to its mission is a great thing. So, intended or not, the ACA may accelerate a trend that already exists as more and more Michigan citizens turn to FQHCs for high quality and accessible medical care.