The community health center (CHC) in the United States is the dominant model for providing integrated primary care and public health services for the low-income and uninsured, and represents one use of federal grant funding as part of the country's health care safety net. The health care safety net can be defined as a group of health centers, hospitals, and providers willing to provide services to the nation's uninsured and underserved population, thus ensuring that comprehensive care is available to all, regardless of income or insurance status.[1][2] According to the U.S. Census Bureau, 29 million people in the country (9.1% of the population) were uninsured in 2015.[3] Many more Americans lack adequate coverage or access to health care. These groups are sometimes called "underinsured". CHCs represent one method of accessing or receiving health and medical care for both underinsured and uninsured communities.
CHCs are organized as non-profit, clinical care providers that operate under comprehensive federal standards.[4] The two types of clinics that meet CHC requirements are those that receive federal funding under Section 330 of the Public Health Service Act and those that meet all requirements applicable to federally funded health centers and are supported through state and local grants.[5] Both types of CHCs are designated as "Federally Qualified Health Centers" (FQHCs), which grants them special payment rates under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). To receive Section 330 grant funds, CHCs must meet the following qualifications:[1][5]
CHCs place great value in being patient-centered. Uniquely in community health centers, at least 51% of all governing board members must be patients of the clinic. This policy creates interesting implications in terms of how "participatory" CHCs are, as governing board members become directly invested in the quality of the clinic. A sliding fee scale based on income is implemented so that the cost of care is proportionate to the patient's ability to pay. The purpose of these stipulations is to ensure that CHCs are working alongside the community, instead of just serving the community, in order to improve access to care.
Community health centers that receive federal funding through the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, are also called "Federally Qualified Health Centers". There are now more than 1,250 federally supported FQHCs with more than 8,000 service delivery sites. They are community health centers, migrant health centers, health care for the homeless centers, and public housing primary care centers that deliver primary and preventive health care to more than 20 million people in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin.