A Commonwealth Fund report found that expansion state FQHCs drove patient care access, care coordination, and behavioral health care access.
Community health centers and federally-qualified health centers in states that have opted into Medicaid expansion offer better patient care access, behavioral health access, and community care than those in non-expansion states, according to a recent analysis from the Commonwealth Fund.
FQHCs are key safety-net facilities, helping to treat underserved individuals across the country. There are currently 1,300 FQHCs operating in 11,000 care sites in the United States. One in 12 Americans receive their care from an FQHC.
These community care organizations have long received bipartisan support, likely because they deter patients from seeking non-emergency treatment in the emergency department, a notoriously expensive place to receive care. FQHCs are also key jobs providers and generate economic activity.
As a part of Medicaid expansion in the Affordable Care Act, the federal government increased funding for FQHCs up to $11 billion over a five-year span. Policymakers anticipated an uptick in FQHC utilization as a result of more patients becoming insured through Medicaid expansion and more affordability on the insurance markets.
“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,” the Commonwealth Fund researchers said. “Medicaid expansion also may incentivize health centers to offer the behavioral health care and nonmedical services that a growing share of patients requires.”
Since ACA passage, FQHCs have lived up to expectations. Positive results are even more pronounced in FQHCs in expansion states.
For example, 69 percent of expansion state FQHCs said they were able to improve their finances, compared to only 41 percent of FQHCs in non-expansion states. Seventy-six percent of those in expansion states also reported more capabilities to meet patient needs and close care gaps, while only 52 percent in non-expansion states said the same.
Expansion state FQHCs are also more likely to be patient-centered medical homes, or to operate under some other value-based care model. Eighty-six percent of expansion state FQHCs are recognized PCHMs, while only 80 percent of non-expansion state clinics are as well.
Seventy-nine percent of expansion state FQHCs also receive reimbursements for hitting clinical quality requirements included in the HEDIS measures.
These findings are particularly notable because they confirm that expansion state FQHCs are meeting patient care needs, improving patient access to care, and improving the quality of healthcare.
Expansion state FQHCs were also more likely to offer comprehensive treatment for opioid use disorder. Forty-four percent of expansion state FQHCs said they offer patient access to medication-assisted treatment (MAT), which is regarded as the standard in OUD treatment. Only 25 percent of FQHCs in non-expansion states said the same.
Additionally, 58 percent of expansion state FQHCs were able to drive care coordination between their clinic and community health partners, compared to only 48 percent of CHCs in non-expansion states.
There is still room for improvement for expansion state FQHCs, the report noted. For example, FQHCs in expansion states have high demand for more mental health and social services providers, with 73 percent and 45 percent reporting such, respectively.
These findings have some policy implications, the report authors stated. As the debate around healthcare reforms continues to roil DC lawmakers, funding from FQHCs and CHCs hangs in the balance. Cutting this funding could threaten safety-net care across the country, the report authors said.
Additionally, potential changes to Medicaid and health insurance eligibility could reduce the number of insured patients, negatively impacting FQHCs and other community health centers.
“Any further weakening of the ACA, like the enactment of Medicaid work requirements and other policies that restrict health insurance coverage, could increase the number of uninsured, thereby reducing health centers’ revenue from insurance and increasing costs,” the researchers concluded. “This ultimately could have a negative impact on the financial stability of health centers. “
Date: April 12, 2019