The Earliest Days

Before 1965
While the first neighborhood health centers were officially launched in 1965, some of today’s community health centers have roots in their communities that go back years or even decades before.

The Earliest Days

1965: First Neighborhood Health Centers Launched
The first “Neighborhood Health Centers" are funded under demonstration authority by the federal Office of Economic Opportunity (OEO), the lead agency in President Lyndon Johnson’s “War on Poverty.” Building on a vision of comprehensive, community-based services, physician leaders Drs. H. Jack Geiger and Count D. Gibson Jr. pioneer the founding of the first two health centers in the nation at Columbia Point, Dorchester, MA, and Mound Bayou, Mississippi, launching a movement in urban and rural areas across the country. The first health center west of the Mississippi opens in 1966 in Denver, CO. Senator Edward M. Kennedy, elected in 1962, visits Columbia Point and begins his life’s work championing care for the underserved and the health center cause.

The National Association of Community Health Centers

1971: The Founding of NACHC
The National Association of Neighborhood Health Centers (later to become NACHC, the National Association of Community Health Centers) is founded by executives of the OEO-funded Neighborhood Health Centers, a demonstration activity in several urban and rural communities across the country. The Association’s objective is to provide education, training and technical assistance to NHC staff and community Board members.

Authorization & Rural Growth

1975 - 1977: CHC Program Authorized and Rural Growth
After  ten years as a demonstration program and a successful battle waged by NACHC and its membership, the Community Health Centers program is authorized for first time as a permanent program under Section 330 of the U.S. Public Health Service Act, initially under OEO and later under the U.S. Department of Health Education and Welfare. The Migrant Health program is also reauthorized as Sec 329 in S. 66 (Public Law 94-63), but only after House and Senate each override President Gerald Ford's veto (requiring 2/3 vote in each chamber). President Jimmy Carter subsequently calls for major expansion of health centers, including the “Rural Health Initiative,” more than doubling program funding over 4 years.

The Reagan Era: Threats & Opportunities

1980 - 1984: Health Centers and the First Reagan Term: Threats and Opportunities
Ronald Reaganis elected Presidenct and calls for sweeping changes in the role of the federal government, proposing the elimination of hundreds of federal programs and block granting to states of others, including Community and Migrant Health Centers. Health centers survive the greatest threat in their brief history as NACHC and its membership fight for repeal of the optional block grant (which is taken by only one state), and return the program to direct federal-local partnership basis. As an economic downturn grips the country in 1982-83, NACHC leads effort to secure $65 million in Jobs Bill funding, equal to 20% of current annual CHC funding. NACHC also leads the successful effort for federal funding in the development of State and Regional Primary Care Associations (S/RPCAs).

The Reagan Era: A Second Term

1985 - 1986: Health Centers and the Second Reagan Term: Resurgence and Expansion
President Reagan is sworn in to a second term in January 1985. Health centers rally sufficient bipartisan support to repeal the block grant and return the program to direct federal-local partnership basis. State and regional Primary Care Associations (PCAs), formed by health centers to monitor state policy developments, receive their first federal funding and recognition. Special Comprehensive Perinatal Care initiative is established under CHC and MH programs, triggering the first new health centers funding since 1981 (except for one-time ‘Jobs Bill’ funding during 1982-83 recession) allowing health centers to develop special activities to reduce infant mortality in low-income and minority communities (P.L.s 99-117. 99-280, and 99-660).

Federally Qualified Health Centers Established in Medicaid, Medicare

1987 - 1992: Medicare and Medicaid “Federally Qualified Health Centers” and FTCA Coverage
The Health Care for Homeless (HCH) program at Sec. 340 of the PHS Act (P.L. 100-77) is established through the Stewart B. McKinney Homeless Assistance Act.
President George H. Bush proposes health center expansion, increasing federal funding by more than $150 million. Congress centralizes health centers' grants administration, establishes Federally Qualified Health Centers (FQHCs) in both Medicaid and Medicare (making services a guaranteed benefit and requiring cost-based payments), and extends malpractice coverage under Federal Tort Claims Act (FTCA) to health centers as the only non-governmental covered entities. Congress creates the new 340 Drug Pricing Program 340B through the enactment of P.L. 102-585, requiring pharmaceutical manufacturers to sell medicines to health centers and other safety net providers at deeply discounted rates. The Public Housing Primary Care Program is established with the enactment of the Disadvantaged Minority Health Improvement Act of 1990. (P.L. 101-527).

The Health Centers Consolidation Act

1995 - 1997: Growth and Challenges: Reauthorization, Managed Care and SCHIP
Despite strong Congressional efforts to block grant or dismantle numerous health programs (including Medicaid), health centers secure 5-year reauthorization and help to defeat the Medicaid block grant. The Health Centers Consolidation Act of 1996 (P.L. 104-299) consolidates funding for Community, Migrant, Public Housing and Homeless health center programs as consolidated authority in Section 330. Congress and the White House subsequently agree to major changes in Medicaid that accelerate the use of managed care systems, including FQHC ‘wrap-around’ payments that eliminate health center losses under Medicaid managed care, but also call for phase-out of Medicaid FQHC payment system. Congress creates new State Children’s Health Insurance (CHIP) program, expanding  coverage for children. NACHC creates, in 1995, the Community Health Corps Program, which subsequently becomes the largest health-focused National AmeriCorps program in the country.

Prospective Payment System

2000: Medicaid FQHC Payments Preserved; Health Center Funding Reaches $1 Billion
Congressional health center supporters stave off the phase-out of Medicaid FQHC payments, replacing it with a Prospective Payment System (PPS) that establishes a per-visit payment syststem to avoid huge revenue losses. NACHC and its members introduce the REACH initiative proposing to double health center funding over 5 years. Both Presidential candidates - Bill Bradley and George W. Bush - embrace REACH and more than 60 percent of Congress support the initial steps. Federal funding for health centers surpasses $1 billion.

Health Center Program Reauthorization

2001 - 2002: Health Centers Programs Reauthorized and Expanded
President George W. Bush fulfills his campaign pledge by calling for 5-year initiative to increase health center funding by $700 million. Congress unanimously reauthorizes the Health Center Program (S. 1533), boosting federal funding for health centers by $175 million in first year, exceeding President Bush’s request

Reauthorization & Expansion

2002 - 2004: Health Centers Reauthorized and Expanded, Major NHSC Reforms
President Bush’s Health Center Growth Initiative receives strong bipartisan support in Congress. Health centers overcome major obstacles to secure 4-year reauthorization of the consolidated Health Centers authority through 2006 (under PHS §330), including new authority to provide operational support to health center-owned/operated networks. Healthy Communities Access Program (HCAP) is launched to coordinate care for uninsured. Congress also reauthorizes for 4 years the National Health Services Corps (NHSC) program, providing an automatic Health Professional Shortage Area (HPSA) designation for all FQHC sites, as well as new requirements that all NHSC sites must agree to “open door” policy and use of sliding fee system. Congress exceeds Bush’s funding requests for health centers, pushing the total health center budget to $1.6 billion for FY 2004 (60% above FY 2000 level), while state funding - despite fiscal crisis gripping most states - approaches $350 million. Later, Congress enacts new Medicare prescription drug benefit (Part D) and other Medicare reforms, including creation of new Medicare ‘wrap-around’ payment system (similar to Medicaid), and establishment of special fraud & abuse ‘safe harbors’ for donated/discounted services, goods and supplies from vendors or other providers.

Advocacy, Bi-Partisan Support Secure Health Center Renewal

2005 - 2008: Medicaid Preserved; Health Center Funding Exceeds $2 Billion
Sensing potential attacks on the Medicaid and SCHIP programs, NACHC forms and leads a coalition of primary care and safety net providers, the Partnership for Medicaid, in fending off most harmful changes to Medicaid in the Deficit Reduction Act of 2005– except for a requirement that states document the legal status of all Medicaid recipients. NACHC and others fend off proposed changes in MUA/HPSA designation methodologies that would have severely limited future growth, and secure unanimous Congressional approval of the Health Care Safety Net Act of 2008 (P.L. 110-355), an historic 4-year reauthorization of both the CHC and NHSC programs. President Bush’s health center initiative doubles the size of the program, reaching 18 million people, as federal funding for CHCs surpasses the $2 billion mark,  twice the FY 2000 funding level, while state funding grows to $590 million. NACHC membership launches the Access for All America (AAA) plan to preserve, strengthen and expand health centers to reach 30 million people by 2015, and ultimately all medically underserved. Presidential candidates of both parties (McCain and Obama) endorse the expansion of community health centers as a public safety net.

Investment and Bold Expansion

2009: Historic Health Center Investment as an Economic Stimulus
Within the first month of new President Barack Obama’s term, Congress reauthorizes (and renames) CHIP; expansion reaches 4 million additional children and incorporates FQHC payment rules. The American Reinvestment and Recovery Act (ARRA) delivers the single largest investment in health center history, providing $2 billion in direct CHC funding to cover the costs of caring for new patients and the capital expenditures required to support expansion, and $300 million for NHSC, Medicaid funding expansions that include assistance to health centers approaching an additional $1 billion for HIT adoption.

Health Reform

2010: Celebrating 45 years of CHC History as Historic Health Reform is Approved
Health reform becomes law in March 2010 with the passage of the Affordable Care Act (ACA), and community health centers feature prominently in a landmark program to expand access, improve quality, and reduce the cost of care for all Americans. In addition to key Medicaid expansions and payment protections, the ACA provides for $11 billion in increased CHC funding over the next five years, to enable health centers to double capacity, and $1.5 billion for National Health Service Corps over five years to substantially expand the number of clinicians in underserved areas.

Health Reform

2011: Elections Usher in Shift in Control, Major Budget Reductions
The 2010 elections shift political control in the House and narrow majority control in the Senate, and new climate is focused on reducing the federal budget and repealing health reform.
With  Federal budget deficit at $14 trillion, house proposals call for unprecedented cuts in domestic spending, block granting Medicaid to the states, and deep reductions to or elimination of many domestic programs. The 2011-2012 federal budget eliminates $600 million in funding from the CHC program and $125 million from NHSC, resulting in a slowdown of health center expansion.

The Primary Care Funding Cliff

2012 - 2013: Growing Capacity and Averting the Funding Cliff
America’s health centers continue to grow, with more than 22 million people served in over 9,000 medically underserved communities in 2012. Still, it was a challenging year. After nearly a year of wrangling and political intrigue, Congress approves legislation on New Year’s Day, 2013 to avert the fiscal cliff and delay for two months a dreaded sequester. The prospect of sequestration - an arbitrary cut to all programs, regardless of effectiveness - imperils the critical progress made by CHCs over the past years. The new year begins with CHC advocates working hard to ensure that should the sequester go through, any reduction in all health center funding would be capped at  2% . Addtionally  advocates sought to ensure that the Administration deploy the full $300 million increase provided within the Health Center Trust Fund for FY13 not only for growth as intended by Congress, but also to offset any sequester funding cut to health centers in lieu of cutting existing health center operations. Finally, with entitlement reform likely to be attached to any legislative vehicle designed to address the debt ceiling or avoid a further sequester, ensuring that Medicaid is not undermined is a key priority.

The Primary Care Funding Cliff

2014: Access is the Answer
Following the open enrollment period that began in October 2013, millions of Americans gain health care coverage—many for the first time—through the health insurance exchanges established under the Affordable Care Act. For FY 2014, $3.7 billion in health center funding has been secured, including $350 million for New Access Points, Expanded Medical Capacity and Service Expansion activities,  and $58 million for Outreach and Enrollment. Still, America’s access deficit— affecting 62 million people, including many with insurance who nonethelss experience poor access to primary care services as a result of local physician shortages—cannot be solved with insurance alone.

President Obama responds to calls to fix the looming funding cliff for health centers, allocating $8.1 billion in new funding over fiscal years 2016-2018. Also proposed is $14.6 billion for primary care workforce initiatives to support growing the National Health Services Corps and training primary-care residents in high-need communities in team-based care approaches, such as Teaching Health Centers, and higher payments to Medicaid providers. The Center for Medicaid Services (CMS) release the final rules for the new Medicare FQHC PPS (prospective payment system) which will go into effect October 1, 2014, and establish a single PPS rate with adjustments based on geography and other factors.

Celebrating the First 50 Years

2015: The 50th Anniversary of the CHC Movement
The passage with overwhelming bi-partisan support of HR 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), follows a concerted effort to tackle the Primary Care Funding Cliff. In addition to extending Community Health Center funding for 2 years, with a total of $7.2 billion in mandatory funds, it also provides extension funding for the National Health Service Corps (NHSC) and the Teaching Health Centers Graduate Medical Education (THCGME) Program, both critical to developing and maintaining the pipeline of CHC clinicians. The successful Children’s Health Insurance Program (CHIP), which provides essential coverage for low-income children, is also extended. The legislation stabilizes federal support for health centers at a time when demand for affordable primary care is growing, and as CHCS nationally celebrate a milestone 50th anniversary.

Hurricane Season and The Community Health Center Fund

2017-2018: Responding to Natural Disasters and Fixing the Cliff

The Atlantic Hurricane season in 2017 is the most catastrophic in history. Hurricane Harvey made landfall in August 2017. In Texas, 51 counties are under disaster declaration, and a state of emergency is declared for the entire state of Louisiana. In early September, Hurricane Irma tears through the Caribbean, striking the US Virgin Islands, Florida and mainland coastal regions in several states. On September 20, following on the heels of an earlier hit by Hurricane Irma, Hurricane Maria rams Puerto Rico, devastating the island where the heavily impoverished population was  already facing critical economic and health challenges.  In all affected regions, CHCs and PCAs are at the front lines, serving a critical role as first responders to a humanitarian and public health crisis, while colleagues at health centers in other states marshall to offer support.

The Community Health Center Fund expired on September 30, 2017, threatening more than 70% of health center federal grant funding and leaving the nation’s health centers in limbo.  A “continuing resolution” passed by Congress in early December provides a short-term extension,  but this stop-gap measure does not include a long-term cliff fix for health centers, nor does a January 2018  budget deal that restores funding for the Child Health Insurance Program. With funding uncertainty mounting, many health centers begin to plan for retrenchment. A bipartisan budget deal is finally passed in February that provides  two years of funding for the Community Health Center Fund at $3.6 Billion for FY 2018 & 2019 and an increase of $200 million for FY 2018 and $400 million for FY 2019.  CHIP funding is extended for another 4 years, providing the program with a total of 10 years of funding. The bill also provides $6 billion of funding to help combat the nation’s opioid crisis. The National Health Service Corps and Teaching Health Centers programs are also extended for two years, providing essential resources to support the workforce and enable health centers to continue caring for their communities. Additionally the budget includes Disaster Relief and Recovery funding to help states and communities recover from the 2017 hurricanes, wildfires and other disasters; $60 million is allocated for disaster funding for community health centers to support construction, alteration, renovation, equipment and other capital improvement costs as necessary to meet the needs of areas affected by Hurricanes Harvey, Irma, and Maria. FY 2018 Capital Assistance for Hurricane Response and Recovery Efforts (CARE) Awards are  announced in September, providing support to 161 health centers in 7 states as well as the territories of Puerto Rico and the USVI. 

The Struggle for Funding Amidst a Global Public Health Emergency

2019-2020: As dual pandemics rage, CHCs fight for long-term, secure funding  

The  116th Congress convenes in January 2019 and the Senate HELP Committee schedules a full committee hearing on “Access to Care: Health Centers and Providers in Underserved Communities,” a display of bi-partisan support for the CHC mission. Yet policy changes such as the Public Charge rule, §1115  Medicaid waivers, and continued  budgetary threats loom. The House votes just dys before the September 30 deadline  to pass a Continuing Resolution to keep the federal government open. It provides a two-month extension of funding for the Community Health Center Fund (CHCF), National Health Service Corps (NHSC), and Teaching Health Center Graduate Medical Education (THCGME) programs. At year-end, another temporary measure extends funding through May 22, 2020, leaving CHCs to begin the new year with uncertainty. When COVID-19 hits the US, CHCs are   once again on the front lines of a global public health emergency. They quickly launch drive-through and curbside testing, adapt facilities and programs to ensure safety, and implement or expand telemedicine, radically changing the delivery of care. While CHCs continue to anchor services in the nation’s poorest and most at-risk communities, they experience large revenue losses as the pandemic forces closure of sites, reductions in non-COVID19 services, and staffing layoffs, losing an estimated $4 billion in 8 months and exposing the huge need for sustained, long-term funding to ensure continued access. Congressional funding relief legislation - including the Paycheck Protection Program (PPP), HHS Provider Relief Fund, HRSA Uninsured Claims Fund, and supplemental COVID-19 grants - provide short-term relief but fall far below the amounts required to fill the gap. Congress ends its session in August with no agreement on a new relief bill. Compounding the large, sustained revenue losses is the uncertainty of ongoing health center funding, with the CHCF set to expire at the end of November 2020.  Also exposed – the deep, pervasive racism that resurfaces with the horrific killings of George Floyd, Breonna Taylor, Ahmaud Arbery, Rayshard Brooks and the shooting of Jacob Blake. Born out of the civil rights and social justice movements of the 1960s, the nation’s CHCs recommit to working for racial equality and real change in the face of systemic injustice, even as they mourn the deep loss first of Rep. Elijah Cummings (MD) and eight months later, of  Rep. John Lewis (GA), champions in the fight for justice and dedicated supporters of the health center movement.

Resilience and Recovery

2021- Health Centers Recognized as the Backbone of Pandemic Response

The American Rescue Plan Act of 2021, part of President Biden's "Build Back Better" agenda, allocates $7.6 billion to community health centers to respond to COVID-19 through investments in testing, vaccinations, workforce and infrastructure. These dollars are on top of $5.7 billion allocated to community health centers for FY2021 through the Consolidated Appropriations Act of 2021. This new federal investment is intended to alleviate many local pandemic-related challenges, and the funding allows health centers nationally to rapidly ramp up and administer 150,000 Covid-19 tests and 253,000 vaccines, on average, in 2021. The Act also provides additional funding for the National Health Service Corps ($800 million), the Nurse Corps ($200 million), and the Teaching Health Center Graduate Medical Education ($330 million) programs, which are essential in providing support for the health center workforce. These robust federal investments demonstrate the extent to which health centers are recognized for their capacity, agility, and quality.  

2022-2023 – Policy Changes Heighten Uncertainty as the Nation Recovers from the COVID-19 Pandemic

As pandemic recovery continues, HRSA announces nearly $90 million in American Rescue Plan funding to support health centers in reducing disparities and advancing health equity through data modernization. On June 24, 2022, the Supreme Court Dobbs v. Jackson Women’s Health Organization decision ends the constitutional right to abortion in the United States. The Dobbs decision has immediate consequences for women’s health care nationwide, as many states facing maternity care shortages enact strict abortion bans, creating greater barriers and burdens to care, especially for women of color and communities served by health centers. As part of the Consolidated Appropriations Act, Medicaid continuous enrollment, authorized under the Families First Coronavirus Response Act, expires March 31, 2023, phasing down enhanced federal Medicaid matching funds and allowing  states to disenroll Medicaid  recipients beginning April 1, 2023. The policy change threatens health centers and their patients, increasing the number of uninsured people and reducing CHC revenue needed to support comprehensive care. President Biden’s proposed FY 2024 Budget supports the extension and expansion of health center funding, while the House Lower Costs, More Transparency Act (H.R. 5378) and Senate Bipartisan Primary Care and Health Workforce Act (S. 2840) support enhanced funding at varying levels. But the Community Health Center Fund, which provides billions in multi-year base grant funding, expires on September 30, 2023 and a short-term continuing resolution creates uncertainty and instability.