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.1 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.2 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.