Document Type

Journal Article

Publication Date



George Washington University Milken Institute School of Public Health Geiger Gibson/RCHN Community Health Foundation Research Collaborative


Policy Research Brief # 43


Affordable Care Act; Community Health Centers; Health Policy; Puerto Rico


In 2014, Puerto Rico’s twenty federally funded community health centers, operating in 71 sites located throughout the Commonwealth, served 330,736 patients, approximately one in ten Commonwealth residents. Compared to other Puerto Rico residents, health center patients are less likely to be insured. Despite considerable growth in Medicaid as a result of the supplemental funding provided under the Affordable Care Act, in 2014, 12.2% of health center patients remained uninsured.

Compared to health centers outside Puerto Rico, Puerto Rico’s health centers show a greater proportion of Medicaid patients served (69% compared to 46% outside Puerto Rico), a greater dependence on physician staffing, and higher performance on most key quality measures. Health centers are key participants in Puerto Rico’s Medicaid managed care program as well as Medicare Advantage and make extensive use of health information technology.

While supplemental Medicaid expansion funding from the Affordable Care Act (ACA) appears to have enabled significant growth in health centers’ service capacity, health centers identified a number of technical and financial barriers to expansion. The ongoing ability of Puerto Rico’s health centers to meet the growing need among higher risk populations for accessible health care depends heavily on the extent to which the structural shortcomings of Medicare and Medicaid financing are addressed.

Peer Reviewed


Open Access