The Community Health Center Fund: In Brief

The Community Health Center Fund: In Brief

Elayne J. Heisler

Specialist in Health Services

Updated May 13, 2019

Congressional Research Service

7-....

www.crs.gov

R43911

The Community Health Center Fund: In Brief

Contents

Background ..................................................................................................................................... 1

CHCF as a Percentage of Health Center Funding ........................................................................... 2

CHCF Grants Awarded .................................................................................................................... 3

Figures

Figure 1. The CHCF and Health Center Funding, FY2011-FY2019 .............................................. 3

Tables

Table 1. CHCF-Supported Grant Programs ..................................................................................... 3

Table 2. CHCF Funds Awarded, by State and Territory .................................................................. 5

Contacts

Author Contact Information ............................................................................................................ 8

Acknowledgments ........................................................................................................................... 8

Congressional Research Service

The Community Health Center Fund: In Brief

Background

The Health Center Program, which is administered by the Health Resources and Services

Administration within the Department of Health and Human Services, awards grants to outpatient

health care facilities that provide care to medically underserved populations.1 The program’s

annual funding has more than tripled between FY2002 and FY2019, increasing from $1.3 billion

to $5.5 billion. This funding increase has resulted in more health centers, more patients seen, and

more services available to these patients.2 The program’s funding increase is due, in part, to the

Community Health Center Fund (CHCF),3 a mandatory multibillion-dollar fund established in the

Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) and extended in

subsequent laws. The most recent two-year extension was included in the Bipartisan Budget Act

of 2018 (BBA 2018, P.L. 115-123). The fund was established in 2011 and is currently available

through FY2019. When the fund was established it was intended to increase health center

appropriations above the level the program received in FY2008;4 however, the CHCF has

partially supplanted annual appropriations since it began. For instance, in FY2010 the

discretionary appropriation for health centers was $2.1 billion, which was prior to the

establishment of the CHCF.5 The FY2011 discretionary appropriation was $1.5 billion, which was

30.3% less than the FY2010 discretionary appropriation; however, combined with CHCF funding

the amount appropriated for health centers in FY2011 was $2.6 billion, which represented an

increase of 23.8% above the FY2010 level.6

The CHCF also supports the National Health Service Corps (NHSC), a scholarship and loan

repayment program that places participating providers in underserved areas, including at health

centers. From FY2012 through FY2017, the CHCF was that program’s sole funding source. In

FY2018 and FY2019, the program received discretionary appropriations to increase the number

of NHSC providers who provide opioid and other substance use disorder treatment.7

CHCF funds have been used for a range of health center activities including funding new health

centers, increasing services provided at existing health centers, and implementing care

coordination initiatives (see Table 1). CHCF funds have also been used to fund health centers in

1 For more information on health centers, see CRS Report R43937, Federal Health Centers: An Overview.

2 Annual discretionary appropriations during this time period and the American Recovery and Reinvestment Act (P.L.

111-5) provided supplemental funding in FY2009 and FY2010. See Table 3 in CRS Report R43937, Federal Health

Centers: An Overview; CRS Report R40181, Selected Health Funding in the American Recovery and Reinvestment Act

of 2009; and Peter Shin et al., Community Health Centers: A 2012 Profile and Spotlight on Implications of State

Medicaid Expansion Decisions, The Kaiser Commission on Medicaid and the Uninsured, Issue Brief, Washington, DC,

September 2014.

3 Section 10503 of the Patient Protection and Affordable Care Act (ACA) established the CHCF. Though the fund is

named for community health centers (the most common type of health center), its funds are available for use by all four

types of health centers: (1) community health centers, (2) health centers for the homeless, (3) migrant health centers,

and (4) health centers for residents of public housing.

4 The FY2008 appropriation was $2.1 billion; see Table 3 in CRS Report R43937, Federal Health Centers: An

Overview.

5 See U.S. Department of Health and Human Services, Health Resources and Services Administration, Justification of

Estimates for Appropriations Committees, FY2013, Rockville, MD, p. 24.

6 See U.S. Department of Health and Human Services, Health Resources and Services Administration, Justification of

Estimates for Appropriations Committees, FY2012, Rockville, MD, p. 16.

7 CRS Report R44970, The National Health Service Corps. In FY2018, the National Health Service Corps received

discretionary appropriations for the first time since FY2012. In FY2019, the NHSC also received $15 million to place

loan repayment recipient providers at facilities funded by the Indian Health Service (see P.L. 115-245).

Congressional Research Service

1

The Community Health Center Fund: In Brief

need of immediate funding, such as those in Flint, MI, which had acute health service needs due

to the discovery of lead in its water supply; those in Puerto Rico and other territories, which had

additional health service needs related to the Zika virus; and those in areas most affected by the

opioid crisis.8

The CHCF represents more than 72% of the Health Center Program’s FY2019 funding. Since its

inception, the CHCF has been extended twice: first, it was extended for FY2016 and FY2017 in

the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10); second, as

stated previously, it was extended in the Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115123), which provided FY2018 and FY2019 funding. MACRA provided $3.6 billion to the CHCF

for each of FY2016 and FY2017 ($7.2 billion total), while BBA 2018 provided $3.8 billion for

FY2018 and $4.0 billion for FY2019 ($7.8 billion total). Under current law, no new funding is

provided for FY2020 or subsequent years.9

This report provides information on the CHCF. Specifically, it includes information on the types

of grants awarded, total funds disbursed, and the amount of CHCF funds that centers in each state

and territory received.

CHCF as a Percentage of Health Center Funding

The CHCF as a total percentage of federal funding for health centers has increased from 40% to

72% from FY2011 through FY2019 (see Figure 1).

8 U.S. Department of Health and Human Services, Health Resources and Services Administration, press releases, “HHS

Awards $500,000 in Funding to Flint Health Centers,” https://www.hhs.gov/about/news/2016/02/18/hhs-awards500000-funding-flint-health-centers.html; “HHS Awards $5 Million to Puerto Rico Health Centers to Fight the Spread

of Zika Virus,” April 26, 2016, https://www.hhs.gov/about/news/2016/04/26/hhs-awards-5-million-to-puerto-ricohealth-centers.html; and “HHS Awards More than $742,000 to Health Centers in American Samoa and the Virgin

Islands to Fight Zika,” June 23, 2016, https://www.hhs.gov/about/news/2016/06/23/hhs-awards-more-742000-healthcenters-american-samoa-and-virgin-islands-fight-zika.html; “FY2016 Substance Abuse Service Expansion Awards,”

https://bphc.hrsa.gov/programopportunities/fundingopportunities/substanceabuse/2016awards/index.html; and “HHS

Makes $350 Million Available to Fight the Opioid Crisis in Community Health Centers Nationwide,”

https://www.hhs.gov/about/news/2018/06/15/hhs-makes-350-million-available-to-fight-opioid-crisis-communityhealth-centers.html.

9 Legislation has been introduced in the 116th Congress that would extend the CHCF funding for five years (H.R. 1943,

H.R. 1983, H.R. 2328, S. 106, S. 192, and S. 962).

Congressional Research Service

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The Community Health Center Fund: In Brief

Figure 1. The CHCF and Health Center Funding, FY2011-FY2019

(Dollars in Millions, CHCF and Discretionary labeled with percent of total)

Source: CRS analysis of HRSA’s Congressional Budget Justifications, P.L. 115-123, and P.L. 115-245 .

CHCF Grants Awarded

ACA’s language creating the CHCF specified rather broad purposes—that the fund be used to

“provide for expanded and sustained national investment in community health centers.”10 CHCF

funds have been used to support operating grants at existing health centers, including grants that

are awarded competitively to existing health centers at the end of their grant cycle that seek

continued funding.11 The CHCF has also been used to support a number of specific initiatives that

seek to expand services and to improve the care provided by health centers (see Table 1).12

Table 1. CHCF-Supported Grant Programs

Name

Description

Funds Awarded

Beacon Community

Supplemental Funding

Grants to support health center HIT

adoption so as to improve health

outcomes, improve care quality, and

achieve cost efficiencies.

$8.4 million (FY2011)

Behavioral Health Integration

Grants to expand behavioral health

services by increasing the number of

providers and services offered.

$54.6 million (FY2014); $51.3

million (FY2015)

10 ACA Section 10503(a).

11 These are referred to as “service area competitions.” Under these awards, HRSA specifies geographic areas eligible

to apply. These awards may be competing continuations (where existing grantees must apply at the end of their grant

cycle) or may be competitions for new areas. See U.S. Department of Health and Human Services, Health Resources

and Services Administration, “Service Areas Competition,” https://bphc.hrsa.gov/programopportunities/

fundingopportunities/default.aspx?id=dcb72c18-c136-411b-bce5-c69a548f6283.

12 The ACA also provided, for use between FY2011 and FY2015, $1 billion dollars for health center construction and

renovation. Grant awards from this program were made in FY2011 and FY2012 and supported 398 projects at 190

centers; see CRS Report R42433, Federal Health Centers.

Congressional Research Service

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The Community Health Center Fund: In Brief

Name

Description

Funds Awarded

Expanded Services

Grants for hiring new staff to extend

hours and expand care that a health

center provides.

$295 million (FY2014); $6.4 million

(FY2015); $7 million (FY2016); $156

million (FY2016 for oral health)

Facility Improvement

Grants for construction and renovations

to increase the number of patients

served.

$260 million (FY2016)

Health Center Controlled

Network-Health Information

Technology (HIT)

Grants to expand the use of advanced

HIT.

$21 million (FY2013); $123 million

(FY2016)

Health Center Outreach and

Enrollment Assistance

Grants to hire staff for in-person

enrollment and eligibility assistance to

uninsured individuals.

$150 million (FY2013); $58 million

(FY2014)

HIV Service Integration

Grants to support HIV services with

primary care service integration.

$5 million (FY2012); $6.2 million

(FY2014)

New Access Points

Grants to support new health center

sites.

$28.8 million (FY2011); $128.6

million (FY2012); $19 million

(FY2013); $150 million (FY2014);

$270 million (FY2015); $51 million

(FY2017)

Opioid and Heroin

Treatment

Grants to expand substance abuse

services at health centers.

$94 million (FY2016); $350 million

(FY2018)

Patient-Centered Medical

Homes (PCMH)

Grants to assist facilities with meeting

the requirements (including facilityrelated requirements) to be certified as a

PCMH.

$32 million (FY2011); $44 million

(FY2012); $35.7 million (FY2014);

$8.6 million (FY2016)

Planning and Development

Grants to support organizations to plan

and become health centers.

$10 million (FY2011)

Quality Improvement/ Base

Adjustment

Adjustments to health center base

funding for ongoing operations and

quality improvement activities.

$48 million (FY2013); $63 million

(FY2015); $100 million (FY2016)

State and Regional Primary

Care Association

Cooperative agreements with state and

regional organizations to provide health

center training and technical assistance.

$5.2 million (FY2011); $6.4 million

(FY2013)

Training and Technical

Assistance

Cooperative agreements to provide

technical assistance to organizations that

support health centers.

$2.8 million (FY2011)

Sources: CRS analysis of data from the HRSA data warehouse; CRS communication with HRSA’s Office of

Legislation, January 5, 2015, December 30, 2016, and May 15, 2018; and HRSA and HHS press releases obtained by

searching http://www.hrsa.gov and http://www.hhs.gov/news/. FY2016 funds were also used to fund health centers in

Flint, MI, and the territories for Zika virus related health services.

CHCF funds were awarded from FY2011 through FY2018 to facilities and organizations in each

of the 50 states, the District of Columbia, and the territories (see Table 2).

Congressional Research Service

4

Table 2. CHCF Funds Awarded, by State and Territory

(Dollars in Thousands)

State

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

FY2017

FY2018

Totala

Alaska

$15,176

$17,176

$21,855

$31,370

$45,789

$48,670

$53,611

$57,246

$233,648

Alabama

$19,803

$23,584

$29,280

$39,000

$58,662

$55,617

$58,600

$61,587

$284,546

Arkansas

$11,634

$13,671

$16,951

$23,823

$37,286

$34,559

$39,961

$41,616

$177,885

American Samoa

$1,089

$901

$1,146

$1,899

$1,348

$2,360

$2,384

$2,456

$11,127

Arizona

$19,016

$20,195

$24,729

$37,004

$52,156

$63,647

$64,899

$64,061

$281,647

California

$120,943

$140,459

$178,975

$275,331

$445,460

$494,221

$493,092

$521,013

$2,148,482

Colorado

$25,431

$29,535

$37,523

$45,921

$62,087

$72,845

$75,681

$74,938

$349,023

Connecticut

$12,973

$15,168

$18,923

$22,080

$35,906

$45,680

$42,957

$47,089

$193,687

District of Columbia

$5,211

$5,852

$6,465

$9,744

$18,315

$20,258

$21,357

$20,474

$87,202

Delaware

$3,290

$4,372

$6,164

$6,280

$7,459

$10,225

$10,283

$10,723

$48,073

Florida

$48,992

$59,567

$73,398

$117,934

$165,216

$170,243

$169,526

$178,611

$804,876

Federated States of

Micronesia

$423

$438

$476

$1,123

$1,836

$2,136

$2,934

$2,715

$9,367

Georgia

$21,338

$26,182

$37,181

$47,576

$73,665

$83,684

$86,411

$94,845

$376,037

Guam

$501

$519

$683

$1,059

$1,460

$1,361

$1,350

$1,463

$6,934

Hawaii

$6,880

$6,795

$8,606

$13,448

$21,135

$23,212

$22,050

$25,303

$102,126

Iowa

$8,507

$9,537

$12,555

$16,899

$27,913

$28,002

$28,604

$30,346

$132,017

Idaho

$9,029

$10,223

$13,255

$18,743

$32,664

$33,182

$33,898

$35,426

$150,994

Illinois

$41,748

$50,739

$64,450

$88,207

$132,420

$144,843

$145,608

$151,396

$668,016

Indiana

$12,420

$13,746

$17,216

$28,441

$48,338

$58,643

$59,062

$60,172

$237,867

Kansas

$7,414

$9,633

$13,030

$18,278

$28,237

$34,513

$34,203

$35,944

$145,308

Kentucky

$13,705

$17,800

$21,803

$31,162

$49,267

$54,770

$58,258

$61,898

$246,765

CRS-5

State

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

FY2017

FY2018

Totala

Louisiana

$17,792

$19,320

$24,680

$43,095

$66,806

$74,742

$77,796

$79,240

$324,231

Massachusetts

$24,757

$26,155

$32,222

$54,646

$81,352

$95,352

$90,527

$100,356

$405,011

Maryland

$13,066

$12,880

$15,336

$26,574

$34,035

$40,760

$40,902

$47,738

$183,552

Maine

$8,751

$9,965

$11,100

$17,724

$30,805

$32,886

$31,988

$35,174

$143,219

Marshall Islands

$295

$306

$338

$704

$785

$808

$756

$807

$3,992

Michigan

$23,770

$27,289

$33,868

$55,030

$89,391

$97,298

$92,650

$100,788

$419,296

Minnesota

$8,829

$10,938

$13,775

$18,646

$28,149

$29,128

$30,680

$33,758

$140,145

Missouri

$20,096

$22,840

$28,811

$45,233

$68,839

$83,065

$79,128

$85,719

$348,012

Mississippi

$18,939

$19,205

$23,681

$34,055

$49,672

$49,916

$52,336

$57,381

$247,804

Montana

$8,669

$10,250

$13,772

$18,292

$27,698

$29,685

$31,574

$33,229

$139,940

North Carolina

$26,443

$31,974

$42,027

$57,132

$95,453

$91,974

$102,757

$104,632

$447,760

North Dakota

$1,989

$1,818

$2,447

$4,211

$7,262

$7,445

$8,393

$8,571

$33,566

Nebraska

$3,830

$4,891

$6,211

$9,385

$12,291

$16,670

$15,322

$16,871

$68,600

New Hampshire

$4,280

$4,927

$7,340

$10,909

$16,817

$18,452

$20,493

$21,437

$83,218

New Jersey

$18,036

$18,534

$25,263

$37,524

$53,364

$62,578

$59,840

$65,209

$275,139

New Mexico

$17,132

$19,064

$25,423

$32,981

$43,138

$55,949

$54,541

$54,620

$248,229

Nevada

$3,963

$3,802

$7,030

$6,265

$11,065

$15,349

$16,079

$15,940

$63,553

New York

$54,434

$69,550

$84,597

$114,257

$177,512

$194,513

$196,883

$206,568

$891,746

$608

$732

$738

$906

$1,041

$1,166

$1,295

$5,191

Northern Mariana

Islands

Ohio

$27,236

$32,877

$37,969

$60,811

$100,662

$108,040

$114,226

$116,687

$481,821

Oklahoma

$12,270

$15,626

$19,901

$22,992

$39,075

$43,577

$42,123

$45,012

$195,564

Oregon

$18,770

$23,679

$29,405

$41,563

$62,124

$67,299

$68,314

$70,891

$311,154

Palau

$358

$31,807

$40,399

$55,918

$811

780.218

732.931

$995

$130,807

CRS-6

State

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

FY2017

FY2018

Totala

Pennsylvania

$27,426

$24,701

$30,063

$38,782

$86,292

$89,813

$88,928

$99,312

$386,005

Puerto Rico

$19,894

$371

$292

$577

$56,486

$67,430

$62,928

$66,606

$207,978

Rhode Island

$7,259

$6,713

$7,671

$11,673

$20,470

$20,970

$21,034

$20,524

$95,790

South Carolina

$20,082

$23,988

$31,938

$37,320

$49,574

$60,102

$60,766

$62,498

$283,770

South Dakota

$4,150

$4,523

$5,597

$8,434

$12,625

$12,131

$13,339

$12,789

$60,798

Tennessee

$17,968

$21,473

$26,400

$36,560

$59,695

$62,397

$60,329

$65,722

$284,822

Texas

$60,674

$68,428

$86,323

$121,729

$184,926

$179,902

$186,745

$195,201

$888,727

Utah

$6,805

$6,834

$10,814

$16,712

$25,117

$29,516

$30,641

$30,261

$126,440

Virginia

$19,223

$22,149

$27,601

$38,361

$56,120

$64,809

$65,272

$65,905

$293,535

Virgin Islands

$673

$789

$959

$1,339

$2,368

$2,351

$2,280

$2,667

$10,759

Vermont

$3,791

$4,126

$5,439

$10,222

$12,865

$22,564

$18,788

$19,118

$77,794

Washington

$27,932

$30,811

$40,902

$57,496

$94,593

$95,990

$95,116

$99,630

$442,840

Wisconsin

$8,327

$11,069

$13,051

$18,617

$32,303

$35,536

$33,162

$36,311

$152,064

West Virginia

$13,499

$15,001

$20,198

$29,218

$46,687

$52,842

$51,149

$56,435

$228,595

Wyoming

$1,730

$1,921

$2,386

$3,999

$6,319

$6,038

$6,188

$6,578

$28,581

Totalb

$978,659

$1,137,296

$1,440,620

$3,502,371

$3,530,603

$3,721,815

$15,855,677

CHCF Allocationc

$1,000,000

$1,200,000

$1,465,000

$3,600,000

$3,516,000c

$4,000,000

$16,436,000

$2,075,045

c

$3,191,077

$2,145,000

c

$3,510,000

c

Source: CRS analysis of HRSA’s Datawarehouse (at http://www.hrsa.gov/data-statistics/index.html) and of data obtained from HRSA, personal communication, February

8, 2018, and February 11, 2019.

Notes: Blank cells indicate that no funds were received by that state or territory in that year.

a. Total indicates the cumulative amount a state has received from the CHCF since the fund began in FY2011.

b. Total indicates amount of grants awarded; it is lower than the amount appropriated to the CHCF as some funds are used by HRSA to administer these grant

programs.

c. The FY2013, FY2014, FY2015, and FY2017 amounts were reduced by the sequester required under the Budget Control Act (P.L. 112-25). For more information,

see CRS Report R43937, Federal Health Centers: An Overview.

CRS-7

The Community Health Center Fund: In Brief

Author Contact Information

Elayne J. Heisler

Specialist in Health Services

/redacted/@crs.loc.gov

, 7-....

Acknowledgments

LaTiesha Cooper, former CRS Research Assistant, and Clarissa Cooper, former CRS Research Assistant,

prepared the tables and figures included in this report.

Congressional Research Service

R43911 · VERSION 12 · UPDATED

8

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