Community Health Centers Report Being More Financially Stable, Better Able to Provide Care in Expansion States

Providing care for 1 in 12 Americans and serving as a safety net for low-income and uninsured people, community health centers fare better in delivering care to these patients in states that have expanded Medicaid, according to an issue brief from The Commonwealth Fund.

According to the brief, health centers in states that have expanded Medicaid are significantly more likely than health centers in nonexpansion states to report improvements in financial stability (69% vs 41%) since the Affordable Care Act was implemented and are more likely to participate in value-based payment models, such as the patient-centered medical home model. The brief also revealed that three-fourths of health centers in expansion states reported being able to better provide affordable care to patients compared with half of health centers in nonexpansion states.

Findings from the report were based on data from the Commonwealth Fund 2018 National Survey of Federally Funded Qualified Health Centers, which the researchers used to compare the experiences of health centers in the 31 states and Washington, DC, that had expanded Medicaid as of September 2018, to those in the 19 states that had not expanded.

“Since health centers serve a disproportionate number of low-income, medically complex patients, it is important to understand if, and how, care delivery itself differs between health centers in expansion and nonexpansion states,” wrote the researchers, who cautioned that those observed differences may be a result of more than just Medicaid expansion, such as whether health centers are located in an urban area and differences in populations of Medicaid expansion and nonexpansion states.

As community health centers often treat low-income and medically complex patients with substance use and mental health disorders, as well as increased social needs, they have a key role in providing both behavioral and social services for these patients. According to the brief, health centers in expansion states are more likely to offer these services, including short-term counseling (89% vs 82%), treatment for substance use disorder (57% vs 48%), and medication-assisted treatment for opioid addiction (44% vs 25%). They are also more likely to coordinate care with social service providers in the community (58% vs 48%) and offer transportation to and from medical appointments (48% vs 39%).

“While many factors other than Medicaid expansion likely influence these differences, the increased Medicaid revenue that health centers in expansion states receive may help them improve the way they deliver care,” explained the researchers. “Medicaid expansion also may incentivize health centers to offer the behavioral healthcare and nonmedical services that a growing share of patients requires.”

However, health centers in expansion states indicated greater staffing needs for these services despite having the budget for them, including licensed mental health providers, such as psychiatrists (73% vs 64%), and social workers or other staff to help connect patients with social services (45% vs 36%).