George Washington University Milken Institute School of Public Health Geiger Gibson/RCHN Community Health Foundation Research Collaborative
Issue Brief #45
Community Health Centers; Medicaid; Affordable Care Act; Primary Care
Community health centers represent a major source of primary health care for the nation’s Medicaid beneficiaries. Because the Federally Qualified Health Center (FQHC) payment system is encounter-based, health centers and Medicaid agencies in ACA expansion states are actively pursuing payment reforms that will enable health centers to adopt strategies that can more effectively respond to the considerable and complex health and social needs of people served by health centers, and more efficiently address the surging volume of patient care. In five expansion states whose alternative payment experiments are underway, health centers and Medicaid agencies are testing payment alternatives, such as global payments, that link payment to performance while ensuring that the FQHC hold-harmless standard is met and that total revenues do not fall below the FQHC floor. These alternative payment approaches enable health centers to test new strategies to address the needs of their patients, while enabling state agencies to align these strategies more closely with broader payment reform efforts.
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Shin, Peter; Sharac, Jessica; Barber, Zoe; and Rosenbaum, Sara J., "Community Health Centers and Medicaid Payment Reform: Emerging Lessons from Medicaid Expansion States" (2016). Geiger Gibson/RCHN Community Health Foundation Research Collaborative. Paper 55.