Federally sponsored health centers are an integral part of the nation’s health care “safety net” (providers who service underserved and uninsured populations) in both rural and urban regions across the United States. Since their inception as a pilot program by the Federal government in 1964, CHCs have been instrumental in delivering primary care medical services to vulnerable populations. They represent a critical public resource for individuals and families who face barriers to securing medical insurance or obtaining care from private providers. Originally supported under the Economic Opportunity Act, the eight inaugural “neighborhood health centers” (NHCs) opened their doors in 1965 as a component of President Johnson’s Great Society plan. With expansions requested in the FY 2004 budget, there will be well over 800 funded Community and Migrant Health Centers with close to 3,700 sites. HHS estimates that CHCs will serve approximately 12.55 million patients during FY 2003 and plans on increasing this number by 1.2 million for FY 2004.
The NHC program was expanded and transferred to the oversight of the Public Health Service in 1969, where it eventually became known as the Community/Migrant Health Center (C/MHC) program. The C/MHC Federal grant program is currently authorized under Section 330 of the Health Centers Consolidation Act of 1996, under the guidance of the Division of Community and Migrant Health Division at the Health Resources and Services Administration’s Bureau of Primary Health Care (BPHC). In its current form, Section 330 governs grants to four types of health centers including community health centers (CHCs); migrant health centers; health care for the homeless clinics; and health care for residents in public housing. Collectively, these grantees are known as Federally Qualified Health Centers (FQHCs). Although the principal subject of the current study are community health centers or CHCs, issues covered will be of general relevance to the broader group of FQHCs and community-based providers.
Although Section 330 mandates certain common elements and requirements for CHCs (see below), they differ substantially in terms of their organization and size. While some operate as primary care physician group practices with a large professional staff scattered around several sites within a community and serving tens of thousands of patients, others operate as single clinician offices with a handful of full-time employees and serving a much smaller population. Furthermore, CHCs exist within a range of larger organizational settings. While all are non-profit organizations, some are church or Foundation sponsored charity clinics, while others have relationships with Universities, non-profit hospitals or other community stakeholders. Given this diversity of organizational partners and size, CHCs differ substantially in terms of their internal management structure. For example, smaller clinics often have a single professional manager who serves as the primary clinician and administrator, whereas larger CHCs often have a Chief Executive Officer (CEO) or Executive Director, a Medical Director and a Chief Financial Officer, each with responsibilities over specific aspects of center administration, clinical services and finances.