Federally Qualified Health Centers in a Changing Health Care Environment: Are They Prepared for the Challenge?

Abstract

In many communities access to primary care is absent, unaffordable, or otherwise inaccessible despite ever increasing demand. Since 1965, Federally Qualified Health Centers (FQHC) have acted as principle providers of primary care for those living in communities lacking adequate access. As of 2013, there were 1,202 FQHCs serving 21.7 million patients, of whom 93% were below 200% of the federal poverty line, 35% were uninsured, 62% were racial/ethnic minorities, 4% were migrants, and 23% were best served in a non-English language. Recently FQHCs received substantial financial support through the American Relief and Recovery Act of 2009 (ARRA), and the Patient Protection and Affordable Care Act of 2010 (ACA). ARRA provided more than $2 billion and ACA provides $11 billion directly to FQHCs for ongoing operations, new service sites, and expanded services. Several additional ACA provisions are expected to bolster the ability of FQHCs to accommodate new demand, while adding and expanding still needed services. Immediately playing the pivotal role expected of them in accommodating the anticipated increase in demand for primary healthcare will be challenging for FQHCs as they also adapt to new organizational structures and payment systems. This dissertation examines the ability of FQHCs to provide primary care services in a changing healthcare environment by evaluating the impact of the recession, ARRA, and ACA on: (1) the demographic and health composition of patients served by FQHCs; (2) the capacity of FQHCs to provide primary care services, and (3) the ability to accommodate the expected increase in demand. Lastly, this work examines the remaining challenges and the implications of those challenges for the future of the FQHC program.