Recent trends in patients, services and funding of community health centers | KFF

key points

Community health centers are a national network of more than 1,300 safety-net primary care providers, serving more than 30 million patients by 2022. They are located in medically underserved urban and rural communities and serve all patients regardless of their ability to pay. Health centers also played an important role in the nations response to the coronavirus pandemic, especially for hard-to-reach populations. This summary analyzes changes in patients, services and health center funding from 2019 (pre-pandemic) to 2022 using the Uniform Data System (UDS), to which all health centers must report annually. Key points include the following:

• The health center’s patient population has returned to pre-pandemic levels after falling during the first year of COVID and has increased slightly from 29.8 million patients in 2019 to 30.5 million in 2022 (2%). But the number of children served by health centers declined slightly from 9.2 million to 8.8 million (4%) over the same period, with the largest decline among children aged 0-5. There is evidence that utilization of primary and preventive services among children on Medicaid remains below pre-pandemic levels, which may partially explain the decline in pediatric patients at health centers.
• Health centers disproportionately served communities of color and low-income people.
• More people were returning to face-to-face care since the start of the pandemic, with more than 105 million in-person health center patient visits in 2022, compared to 85.7 million in 2020, but the telehealth was still used in 17% of all visits in 2022.
• Between 2019 and 2022, the number of visits to mental health and substance use disorder services increased by 21%, with large increases in the number of patients diagnosed with anxiety disorders (up 26%) and attention deficit (21% increase). The number of patients receiving medication-assisted treatment (MAT) for opioid use disorder increased by 36% from 2019 to 2022.
• Between 2019 and 2022, the share of health center patients who are uninsured fell from 23% to 19%, while the share of patients covered by Medicaid increased from 49% to 51%, likely due to the Medicaid continuous enrollment provision that was there. from March 2020 to March 2023.
• Medicaid was the largest source of revenue for health centers, providing 42% of all revenue in 2022, while federal grant funding accounted for 12% of total funding. Health center revenues increased by more than $11 billion since 2019, primarily due to growth in Medicaid funding related to the increase in Medicaid patients and funding related to COVID.

Deactivation of Medicaid’s continuous enrollment provision will likely affect patients, services and health center funding starting in 2023, as people who opt out of Medicaid either enroll in other coverage or not have insurance KFF tracking indicates that more than 20 million people have disenrolled from Medicaid since the phase-out began. Early research using health center claims data found that 17 percent of patients covered by Medicaid before the relaxation began were uninsured when they sought care at a health center during the first six months of relaxation . Among those with the highest Medicaid disenrollment rates were patients with HIV/AIDS, mental health problems, or SUDs. Although Congress recently reauthorized increased federal grant funding for health centers through 2024, the increase may not fully offset any drop in Medicaid revenue during the shutdown. The expiration of pandemic-related funding could further strain health center finances.

Health Center patients

The number of patients treated by health centers increased in 2022, although the number of child patients has not fully recovered to pre-pandemic levels. After temporary site closures and social distancing guidance at the start of the coronavirus pandemic in 2020, the number of patients dropped, but in 2021, the number of patients began to rise again and this trend continued in 2022. Health centers treated 30.5 million patients in 2022. , an increase of 2% compared to 2019 (Figure 1). Although the number of adult patients increased, the number of child patients decreased by 4% and remains below the number of children treated in 2019.

Health facilities saw fewer children aged five and under in 2022 compared to 2019, driving the overall decline in pediatric patients. Between 2019 and 2022, the number of children aged 0-5 visiting health centers decreased by 14% from 3.2 million to 2.7 million (Figure 1). The largest drop in the 0-5 age group occurred among children under 1, which decreased from 688,000 patients in 2019 to 471,000 in 2022 (a 32% drop). There was a smaller decrease in the number of patients aged 6-11 (3%), while children aged 12 and over saw a 5% increase over the number of patients before the pandemic.

The majority of health center patients were people of color, and the vast majority were low-income. In 2022, people of color made up 63% of health center patients, and Hispanics were the largest proportion of patients at 39% (Figure 3). Health centers also served many patients with limited English proficiency, with about one in four patients (26%) being best served in a language other than English. Reflecting their role as safety net providers, nine out of ten health center patients had incomes at or below 200% of the federal poverty level (FPL), and two-thirds (66%) had incomes at or below less than 100% FPL in 2022. (Figure 3).

Health Center Services

Although health center patients returned to face-to-face care in 2022, reliance on telehealth continued. Healthcare facilities provided a total of 126.9 million visits in 2022, including 21 million telehealth visits (Figure 4). Telehealth visits accounted for 17% of total visits, a substantially larger share than the 2019 baseline of less than 1%, but below the peak of 25% during the peak of the pandemic in 2020. While in-person visits increased from 2020, they remained below pre-pandemic levels.

Mental health, substance use disorder (SUD) and medical services drove the growth of visits to health centers between 2019 and 2022, while visits for dental and vision services remained below of pre-pandemic levels. Overall, visits to health facilities were 3% higher in 2022 compared to 2019. Visits for mental health and SUD services increased by 21%, with more modest growth for habilitation services (9% ) and medical services (4%) (Figure 5). Services that were largely delivered face-to-face, such as vision and dentistry, declined by 3% and 17%, respectively, over the same period.

Consistent with the increase in mental health and SUD visits, the number of health center patients diagnosed with certain mental health disorders and SUD increased in 2022. Compared to 2019, in 2022 there was a notable increase in the number of patients with anxiety disorders (26%) and attention deficit and conduct disorders (21%) (Figure 6). In addition, the number of patients receiving medication-assisted treatment (MAT) for an opioid use disorder increased by 36% from 2019.

Sources of income for the health center

The share of health center patients who were uninsured continued to decline, while the share of Medicaid enrollees exceeded 50%. From 2019 to 2022, the share of uninsured patients dropped four percentage points from 23% to 19%, while the share of patients with Medicaid increased from 49% to 51%, further cementing Medicaid as the top source of coverage for patients (Figure 7). Both changes are largely attributable to Medicaid’s continuous enrollment provision, which temporarily halted Medicaid disenrollments from March 2020 to March 2023. After March 2023, states resumed disenrollments as part of the Medicaid opt-out.

Medicaid remained the largest source of revenue for health centers, although federal grants and funding related to COVID-19 were also important sources of revenue in 2022. Medicaid accounted for 42% of health center revenues in 2022, while federal Section 330 grant funding, which supports health centers’ role as safety net providers, accounted for 12% of income of health centers at national level (Figure 8). In addition, pandemic-related funding accounted for 8% of all health center revenues by 2022, although this funding has since expired. Health center revenues increased by more than $11 billion since 2019, primarily due to growth in Medicaid funding related to the increase in Medicaid patients and funding related to COVID.