# The Community Health Center Fund: In Brief

> Briefs, arguments, decisions, and more.

URL: https://www.frixlaw.com/law-library/documents/crs%3AR43911

## Record

- **Collection:** Congressional research report
- **Document type:** CRS Report
- **Published:** May 13, 2019
- **Citation:** R43911

## Text

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

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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).

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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.

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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

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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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