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George Washington University, School of Public Health and Health Services, Department of Health Policy


Geiger Gibson/RCHN Community Health Foundation Research Collaborative Policy Research Brief No. 30


Medicaid & SCHIP; Access to Health Care; Community Health Centers; Legal; Disparities; Health Reform


The nation's federally funded health centers are the principal source of primary health care for medically underserved populations. In CY 2011, more than 1,200 health centers, operating in more than 8,500 urban and rural locations, served 20.2 million patients, 36 percent of whom were uninsured and 93 percent of whom had family incomes below twice the federal poverty level. Federal grants provide core support to health centers, but Medicaid represents the largest single health center financing mechanism, accounting for 39 percent of revenues. Medicaid revenue growth allows health centers to preserve their core grant funding to reach uninsured patients while exerting a cumulative financial impact on overall patient care capacity.

Following passage of the Affordable Care Act (ACA), the Geiger Gibson program estimated the combined effects on health center expansion of the ACA's Health Center Growth Fund, its Medicaid expansion provisions, and its establishment of subsidized private health insurance markets through state Exchanges. We concluded that together, these reforms would enable health centers to add 19.8 million new patients by 2019, more than doubling the number of people served.

The United States Supreme Court's Medicaid holding in NFIB v. Sebelius has the potential to limit the impact of the ACA Medicaid expansion by barring the HHS Secretary from withholding current Medicaid funding from states that fail to cover the expansion population. Using estimates of the potential impact of the Court's holding on Medicaid coverage for the poorest Americans, we quantify the effect on health centers and their patients if states indeed fail to implement the expansion.

If fully implemented by the States, Medicaid expansion will enable health centers to reach approximately 19.8 million new patients. Conversely, without the Medicaid expansion, health centers' new patient care capacity would be reduced by nearly 27 percent, a 5.3 million drop in new patients served. Of the new patients losing services, less than half (44 percent) would have been covered under Medicaid. More than half (55 percent) would have been uninsured, Medicare beneficiaries or patients who obtain coverage through their employers or state health insurance Exchanges. Among the 10 states whose Governors had most clearly indicated by mid-July 2012 that they did not intend to implement the Medicaid expansions,1 new health center patient care capacity would decline by more than 1.5 million patients, from nearly 8.9 million patients served by 2019 to 7.3 million.


Funder: RCHN Community Health Foundation.

Open Access