With the federal government's Community Health Center Fund (CHCF) due to expire at the end of September, community health centers are facing the possibility of having to limit services, close sites, and/or lay off staff, a report from the Kaiser Family Foundation and the Geiger Gibson Program in Community Health Policy at the George Washington University finds.
Established in 2010 by the Affordable Care Act, CHCF accounts for 72 percent of all federal health center grant funds and 18 percent of total revenue for the nearly fourteen hundred community health centers nationwide — including 26 percent of revenue for centers in states that have not expanded Medicaid eligibility. Based on survey responses from more than five hundred community health centers in forty-nine states and the District of Columbia, the report, Community Health Centers Prepare for Funding Uncertainty, found that community health centers anticipating a delay in a congressional extension of CHCF are considering or have taken steps that could affect access to care for some twenty-eight million patients in medically underserved rural and urban areas.
According to the survey, more than half of respondents were considering instituting or had instituted a hiring freeze (52 percent and 8 percent), tapping or spending down reserves (45 percent and 8 percent), or canceling or delaying a planned facility renovation or expansion (42 percent and 10 percent). In addition, many respondents were considering or had gone through with canceling or delaying investments in quality improvement or infrastructure (41 percent and 6 percent), cutting staff hours (38 percent and 3 percent), reducing their hours of operation (33 percent and 2 percent), or closing one or more sites (23 percent and 2 percent). And while fewer than 2 percent of respondents had already cut or reduced their services, far more said they already had or were thinking about scaling back non-clinical services such as case management, transportation, and education (39 percent), as well as dental (25 percent), medical (23 percent), mental health (20 percent), substance use disorder treatment (17 percent), pharmacy (12 percent), and vision (11 percent) services. The report also found that community health centers in states that have not expanded Medicaid eligibility were more likely to be considering cutting or had already cut hours, locations, and/or services.
"In 2017, the CHCF lapsed for five months before Congress extended it for two years," the report's authors note. "Although funding was ultimately restored, health centers around the country reported that they faced difficult decisions to reduce care, close service sites, and lay off staff because of the delay."
Although a House bill (HR 2328) to extend the fund through fiscal year 2023 and a Senate bill (S 1895) to extend it through fiscal year 2024, both at current funding levels, have advanced out of committee, they were not voted on before Congress adjourned for its August recess.