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Commonwealth Fund: The Role of Medicaid Expansion in Care Delivery at Community Health Centers

Community health centers provide comprehensive primary care to medically underserved communities, regardless of patients’ insurance status or ability to pay. Health centers have enjoyed bipartisan support for decades, because they provide affordable, cost-effective care for millions of Americans while saving the overall health care system money. When people gained insurance coverage under the Affordable Care Act (ACA), it was expected that reliance on health centers would increase. As a result, Congress doubled federal grant funding for centers and created incentives for clinicians to practice in them.

Previous research has shown that health centers in states that expanded Medicaid have particularly benefitted from the ACA. But less is known about how the delivery of health care in centers has changed. This brief uses data from the Commonwealth Fund 2018 National Survey of Federally Qualified Health Centers to compare the experiences of health centers in states that have and have not expanded Medicaid.

Highlights

• Health centers in Medicaid expansion states, compared to those in nonexpansion states, were significantly more likely to report improvements in their financial stability (69% vs. 41%) and in their ability to provide affordable care to patients (76% vs. 52%) since the ACA took effect. They have also been somewhat more likely to operate under a value-based payment model, like the patient-centered medical home.
• Health centers in Medicaid expansion states were more likely to offer medication-assisted treatment for opioid addiction (44% vs. 25%), provide counseling and other behavioral health services, and coordinate patient care with social service providers in the community (58% v. 48%) than health centers in nonexpansion states.
• However, health centers in states that expanded Medicaid were more likely than those in nonexpansion states to report unfilled job openings for mental health professionals (73% vs. 64%) and social service providers (45% vs. 36%), perhaps indicating higher demand for these professionals and insufficient supply.
• While many factors account for the observed differences between expansion and nonexpansion states, community health centers appear to benefit from Medicaid expansion. If Congress does not renew federal funding for health centers this year, there could be a reversal in these gains, jeopardizing the health care safety net in communities throughout the United States.

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