Required Disclosure The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose.

Health Centers and Health Care Reform: Where We’ve Been and Where We’re Going APHA Boston, 2013 Kaitlin M. McColgan Director of Federal Affairs National Association of Community Health Centers

America’s Voice for Community Health Care The NACHC Mission To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.

America’s Health Centers Community, Migrant, Homeless, and Public Housing Health Centers 45 years of high-quality, affordable, primary and preventative care. Serve more than 22 million people at more than 7,500 sites located throughout all 50 states and U.S. territories.

What is a health center? 4 Basic Requirements: 1.Open to All- Regardless of Ability to Pay. 2.Consumer-majority Community Board. 3.Comprehensive Primary Care Services. 4.Located in Medically-Underserved Area (MUA) or Serving Medically Underserved Population (MUP).

Health Center Patients Today Health Centers serve as the medical and health care home for more than 22 million nationally. This includes : 1 in 7 Medicaid beneficiaries 1 in 7 uninsured persons, including –1 in 5 low income uninsured 1 in 3 individuals in poverty –1 in 4 minority individuals in poverty 1 in 7 rural Americans * Includes patients of federally-funded health centers, non-federally funded health centers or “Look-Alikes”

EthnicityRace Most Health Center Patients Are Racial and Ethnic Minorities, 2012 Please refer to sources and methodology at the end for more information Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Based on percent known. Percents may not total 100% due to rounding. Hispanic or Latino 34% All Others 66%

Health Center Patients Are Predominately Low Income *Please refer to sources and methodology at the end for more information Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS % FPL 14% % FPL 7% Over 200% FPL 7%

Most Health Center Patients are Uninsured or Publicly Insured Other public may include non-Medicaid SCHIP and state-funded insurance programs. Source: Federally-funded health centers only Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS. Note: Percents may not total 100% due to rounding. Please refer to source and methodology at the end for more information.

What was Health Reform about to health centers? Coverage PLUS Access Expanded coverage for the people & communities served by CHCs, Guaranteed funding to expand CHCs & the NHSC to reach 40 million by 2015 AND Changes designed to revitalize (or at least re- emphasize) primary care: THCs, training, payment improvements and promotion of integrated care for better quality & lower costs

Health Center Funding in ACA The Affordable Care Act (ACA) provided $11 billion in dedicated funding for health center operations and capital for FY2011-FY2015. –$9.5 billion to support health center operations. –$1.5 billion for capital needs. Stated goal of doubling patients to 40 million by 2015 Health Centers“the foundation”. Changing political environment, budget cuts, sequester = much smaller patient growth than envisioned.

The Health Center Funding Cliff Community Health Center Funding: FY 2010 – FY 2016

What purpose does the grant serve today? Enables CHCs to: Locate in underserved areas where market won’t support other providers; Remain open to all: uninsured, underinsured, patients others can’t or won’t see; Provide comprehensive services which improve health and lower system costs. What role does the grant have in the future? The exact same. The Health Center Grant

Expectations game... What Massachusetts tells us... - LOTS more patients (+43% increase); existing patients “voting with their feet” (and staying); continued high #’s of uninsured (MORE than pre- health reform); chronic disease burden, social determinants. Exchange Contracting + Payment issues -Weak rules; will CHCs be left out? Still FQHCs and 330 grantees- by law and mission.

Unanswered Questions... Is ACCESS still a part of the conversation? Will the Health Center Cliff get fixed? What about workforce?

Where Can I Get More Information? Our Website: – NACHC.org > Policy Issues > Federal NACHC.org > Policy Issues > Federal Blog: – Health Centers on the Hill Health Centers on the Hill Washington Update: – Sign up to be a Health Center Advocate Sign up to be a Health Center Advocate Join the Campaign for America’s Health Centers!Campaign for America’s Health Centers

Thank You! Any Questions?