Primary Health Care

Health Centers

Authorizing Legislation - Section 330 of the Public Health Service Act, as amended and the Native Hawaiian Health Care Improvement Act.

FY 2008 Authorization.........................................................................................................Expired

Statement of the Budget Request - The FY 2008 Budget of $1,988,467,000 is an increase of $223,751,000 above the FY 2007 Continuing Resolution (CR).

Program Description - The Health Center program, a major component of America’s health care safety net for the Nation’s indigent populations for more than 40 years, is leading Presidential Initiatives to increase health care access in the Nation’s most needy communities.

The President’s Health Centers Initiative - The President’s Health Centers Initiative, which began in Fiscal Year (FY) 2002, will significantly impact 1,200 communities through the support of new or expanded access points and significantly expanded sites. This expansion complements the President's efforts to increase health insurance coverage in private and public insurance programs, and to help increase access to health care. The President’s Health Centers Initiatives will broaden the Health Center safety net and increase access to primary health care for the Nation’s underserved populations. Due to the current pressures on State budgets and increasing numbers of uninsured and under-insured populations, the Federal Health Center grant is more important now than ever.

The Health Center Program completed the first five years of the first Initiative (FYs 2002 through 2006) with a strategy that focused on three key elements: 1) Strengthening existing Health Centers; 2) Managing the growth of new Health Centers; and 3) Managing quality improvement in all Health Centers. Through FY 2006, this strategy has resulted in the creation of 514 new access points, the provision of 385 grants to significantly expand the medical capacity of existing service delivery sites, and the award of more than 340 grants to existing grantee organizations for the expansion of oral health, mental health and substance abuse services. In 2005, the Uniform Data System indicated that the number of Health Center patients increased by 1,000,000 for a total of nearly 3.8 million additional patients since 2001. As a result of FY 2006 expansion activities supported by the President’s Health Centers Initiative, it is estimated that the Health Center program served more than 700,000 additional patients.

In their competitive applications for grants funded under the President’s Health Centers Initiative, Health Centers estimate the number of additional patients they will be able to serve with the increased support. However, as with any business, the ‘ramp-up’ process may take more than one year to reach that capacity. Currently, we estimate that Health Centers will achieve 80 percent of their added capacity in the first year and the remaining 20 percent in the second year.

Health Center Program - Health Centers, operating at the community level, provide regular access to high quality, family oriented, comprehensive primary and preventive health care, regardless of ability to pay, and improve the health status of underserved populations living in inner city and rural areas. Between 2001 and 2005, the number of Health Center patients increased by about 3.8 million for a total of 14.1 million, an increase of 37 percent.

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Health Centers serve clients that are primarily low income and minorities including migrant/seasonal farmworkers; homeless individuals and families; people living in areas with high levels of crime; people living in rural and sparsely populated areas; large numbers of unemployed and impoverished people with chronic diseases, pregnant teens, substance abusers, and many individuals living with HIV/AIDS infection. These clients have difficulty obtaining health services outside of a Health Center and many require translation/interpretation services. Health Center target populations that have lower life expectancy and higher death rates compared to the general population. These patients have less purchasing power, and many are unable to afford even the most basic medical or dental care.

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In Calendar Year (CY) 2005, almost 36 percent of Health Center patients were covered by Medicaid, 7.5 percent were covered by Medicare, 17.1 percent were covered by other public or private insurance and over 40 percent were uninsured.

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A Health Center commitment to serving the uninsured results in a significant uncompensated care burden. In CY 2005, 5.6 million (39.8 percent) Health Center patients were uninsured, an increase of 1.6 million uninsured patients or 41 percent from CY 2001.

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In CY 2005, approximately 13 million Health Center patients were at or below 200 percent of poverty, a 43 percent increase over CY 2000.

Health Center patients:
63.6 percent are minorities
59 percent are females
25 percent are children under age 12
44 percent live in rural areas
more than 795,000 are homeless
777,000 are migrant/seasonal farmworkers

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Emerging Population Groups That Pose Unique Cultural And Health Care Problems:

Health Centers serve increasingly culturally diverse people, which reflects a significant increase in the U.S. foreign-born population. Center providers have developed creative and successful culturally and linguistically competent practices to serve these diverse population groups. These practices include interpreter services, multi-lingual providers, cultural competence training for staff and targeted outreach programs. Twenty-nine percent of Health Center patients are best served in a language other than English or with sign language. More than 89 percent of Health Centers provide on-site interpretive services which can include patients from five to twenty different cultural groups requiring providers to understand as many as twenty different languages or dialects. In addition to addressing primary care needs, Health Centers provide information and eligibility assistance for associated benefits such as the State Children’s Health Insurance Program (SCHIP) and Medicaid for all patients, including those that are non-English speaking. Therefore, translation services and bilingual providers are a critical component of quality health and social services for those who have limited English proficiency.

Health Centers Serving Special Populations - The Health Center program encompasses a number of types of Centers designed to meet the health care needs of specific populations, i.e., migrant and seasonal farmworkers, homeless people, at-risk school children, residents of public housing, and indigenous people of jurisdictions associated with the United States. The Health Center appropriation also includes funds for the Native Hawaiian health care program.

Migrant and Seasonal Farmworkers - The Migrant Health program provides comprehensive, high quality, family-based preventive and primary health services to migrant and seasonal farmworkers (MSFWs) and their families with a culturally sensitive focus. Special outreach and environmental initiatives are offered.

A migrant farmworker is defined as an individual whose principal employment within the last 24 months is in agriculture and who establishes for the purposes of such employment a temporary residence. There are approximately 3-5 million MSFWs in the United States. About 70 percent live below the poverty line with an average income of less than $7,500 per year. About 80 percent are Latinos, with an educational level of less than 6 years of formal schooling. There are also large numbers of Haitian, African American and Asian farmworkers throughout the country. They have limited access to health care while working in one of the most hazardous occupations. They live and work in substandard conditions including low wages, geographic isolation, lack of sanitary facilities, substandard housing, and face barriers of language and culture. They also face the consequences of life on the road including lack of a continuity of needed health services.

For Migrant Health Centers - In CY 2005, Migrant Health Center grantees reported that:

• 54 percent of patients were uninsured
• 46.3 percent were male; 53.7 percent were female
• 93 percent were Hispanic; 4 percent were White and 2 percent were African American
• the largest number of migrant patient medical encounters were for well child care; immunizations; diabetes; hypertension; pap tests; alcohol and drug dependence and other mental disorders.

In CY 2005, primary care services were provided by 135 grantees located in 40 States and Puerto Rico to more than 729,000 migrant and seasonal farm workers including their families. An additional 47,000 migrant/seasonal farm workers were patients at Health Centers that did not receive Migrant Health Center funding.

Homeless Populations - Health Care for the Homeless Centers provide homeless individuals and families with access to high quality, comprehensive preventive and primary care services, including oral health, mental health, and substance abuse services. These health services are provided in settings that promote access to and utilization of services, e.g., in homeless shelters, on the street, and from mobile clinics. Outreach and case management services are included so that health services are more accessible.

A homeless person is defined as an individual who lacks housing, including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations, and an individual who is a resident in transitional housing. Health Care for the Homeless Centers are the source of care for approximately 650,000 people per year, about 20 percent of the estimated 2 to3 million persons who are homeless in the U.S. over the course of a year.

In CY 2005, Health Care for the Homeless grantees reported that:

• 71 percent of program patients were uninsured
• 57 percent were male; 43 percent were female
• 50 percent were ages 20 to 44; 17 percent were under 20
• 39 percent were African American; 36 percent were White; 21.9 percent were Hispanic;
  1.5 percent were American Indian/Alaska Native; and 2 percent were Asian/Pacific
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• 45 percent lived in homeless shelters; 10 percent lived on the street; the remainder lived in transitional housing, doubled up with friends or family, or had other living arrangements
• the largest number of homeless patient medical encounters were for alcohol and drug dependence and other mental disorders. The next largest number of medical encounters were for hypertension and diabetes.
• in addition to being largely uninsured and poor, homeless individuals face the social and medical consequences of life without continuity of shelter, safety, food, and sanitation

In CY 2005, homeless health care services were provided by 176 grantees to approximately 653,000 homeless individuals located in all 50 States, the District of Columbia and the Commonwealth of Puerto Rico. An additional 154,000 homeless individuals were patients at Health Centers that did not receive Homeless Health Center funding.

Residents of Public Housing - Public Housing Primary Care Centers improve the health status of public housing residents by delivering comprehensive, accessible and affordable preventive and primary care services from sites that are in, or adjacent to, public housing developments. Residents of public housing face geographic isolation, and high rates of crime, overty, and chronic disease. By training and employing residents, providing health education, primary care and enabling services, and prevention programs, these Public Housing Health Centers help overcome this isolation by becoming the hub of the community. They help address uncontrolled chronic disease by being Centers of health and by providing social service improvement activities.

In CY 2005, the program grantees reported:

• 84 percent of public housing primary care users were below 100 percent of poverty;
• 46 percent were enrolled in Medicaid or SCHIP;
• 43 percent were under 20 years of age;
• more than 90 percent of Public Housing Health Center patients were minorities; 43 percent were African American and 42 percent were Hispanic; and
• well child care, immunizations, mental disorders, hypertension and diabetes are the most frequently reported causes for medical encounters

In CY 2005, 36 Public Housing Health Center grantees provided services to more than 122,000 individuals.

Native Hawaiians - The Native Hawaiian Health Care Program, funded within the Health Center appropriation, improves the health status of Native Hawaiians by making health education, health promotion, and disease prevention services available through the support of Native Hawaiian Health Care Systems. Native Hawaiians face cultural, financial, social, and geographic barriers that prevent them from utilizing existing health services. In addition, health services are often unavailable in the community. The Native Hawaiian Health Care Systems use a combination of outreach, referral, and linkage mechanisms to provide or arrange services. Services provided include nutrition programs, screening and control of hypertension and diabetes, immunizations, and basic primary care services.

For 2006:

• Native Hawaiian Systems provided medical and enabling encounters to more than 6,163 people.
• The largest number of medical encounters were for heart disease, hypertension and diabetes.

The Native Hawaiian Health Care Program also supports a health professions scholarship program for Native Hawaiians and administrative costs for Papa Ola Lokahi, an organization that coordinates and assists health care programs provided to Native Hawaiians. In FY 2006, 11 Native Hawaiian scholarships were awarded. More than 170 Native Hawaiian scholarships have been awarded since the beginning of the program.

Health Center Services - In many areas, Health Centers are the only primary care facilities readily available to community residents in underserved or high need areas. They overcome access barriers due to geography, language, culture, poverty, housing status, migration, etc. They provide accessible, affordable, high quality, comprehensive, case managed (coordinated follow up) health care and related services for indigent populations including adult medicine, infectious diseases, OB/GYN, pediatrics, dentistry, pharmacy, mental health and substance abuse treatment programs, school health programs that focus on child and family health issues, disease prevention and health promotion lifestyle programs, night and weekend operation hours, transportation, outreach, translation, and other enabling services.

In CY 2005, Health Centers provided:

• more than 55 million encounters
• more than 285,000 mammograms
• over 1.5 million pap tests
• 3.01 million encounters for immunizations
• nearly 468,000 HIV tests and counseling
• perinatal and delivery care for 397,000 women
• translation services to more than 3.9 million patients

Health Centers Reduce Disparities - HRSA is committed to implementing strategies that will move toward the elimination of major health disparities among our Nation’s vulnerable populations. Health Centers serve low income and minority populations that experience much higher rates of many diseases including diabetes, cardiovascular disease, asthma, cancer, and HIV/AIDS than the National average. These differences may be aggravated by these same peoples’ inability to obtain appropriate pharmaceuticals due to high costs and delays in getting necessary health care treatment unless emergency conditions exist. The result can be poor health outcomes compared to the national population.

Everyday, Health Centers work to improve health by:

• Reducing disease and morbidity/mortality in targeted clinical areas
• Increasing health care utilization for underserved populations
• Adapting services to meet population needs
• Building and maintaining a diversified health care workforce
• Increasing the cultural competence of their health care workforce
• Enhancing and establishing new partnerships
• Translating clinical knowledge into clinical practice
• Improving the patient office visit
• Enhancing clinical data collection on health outcomes
  

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Because Health Centers offer such high quality services and access to an usual and regular source of primary care which is absolutely essential for improvements in health status, many patients have greater access to preventive services. On a National basis, up-to-date mammography rates for low income African American, Hispanic, Medicaid, and Uninsured women fall far short of the HP 2010 goals of 70 percent. These vulnerable women historically face barriers to access to care. Yet the rates for Health Center women 40 years of age and older from these groups far exceed those of comparable women in the Nation. In three of four cases, Health Center rates even exceed the HP 2010 goal. Health Center women from these groups also record higher rates of up-to-date pap tests and clinical breast exams than comparable National groups of women.

Babies delivered to patients who obtained their prenatal care at Health Centers in 2005 including African American newborns, had better birth weight outcomes than all infants born in the U.S. and all African American infants born in the U.S., respectively.

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According to data published in recent journal articles and the latest survey and medical claims analysis:

• Health Center patients have lower ambulatory visit costs and lower rates of hospitalizations and associated costs than patients with other types of primary care providers.
  
• Health Center patients have improved management of chronic diseases compared to the general population:
  
  • African American and Hispanic hypertensives seen at Health Centers are three times as likely to report blood pressure under control
  • Diabetics receiving care at Health Centers are twice as likely to have glycohemoglobin tests on schedule

Health Centers are providing quality chronic disease management and are taking advantage of opportunities to provide recommended preventive care. Diabetes patients treated at Health Centers were not only more likely to receive secondary preventive services, such as eye and foot exams, but were likely to receive other recommended preventive services than similar patients who obtained care elsewhere.

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[1] Politzer, et al., Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities
in Access to Care, June 2001.

Health Centers provide increased preventive services to their patients; for example, uninsured patients are more likely to be counseled at Health Centers about dieting and eating habits, physical activity, smoking, drinking, drugs, and STDs than comparable uninsured patients in National samples.

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Health Centers have a commitment to high quality of primary and preventive care that significantly enhances their patients’ long term health status. One of the best measures of effectiveness of care is when patients report that the Center is their regular and usual source of care. In recent surveys of the Nation’s and Health Center uninsured - those most likely to have access problems - of those that obtain care at Health Centers, virtually all report that the Center is their medical home compared to 65 percent who obtained their care elsewhere. It is also important to note that the HP 2010 goal is 90 percent, and Health Centers have exceeded that goal as well

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Also, Health Centers, unlike most other providers, do not select their patients as to whether they carry an insurance card. Health Center uninsured patients visit just as frequently as those who have insurance - unlike many of the Nation’s uninsured who are frequently deterred.

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Strengthening the Safety Net - HRSA and its Health Center grantees have pursued a host of strategies to strengthen existing safety net providers and to expand effective, quality care to more of the underserved. The strategies for strengthening existing providers are: The Health Disparities Collaboratives, Integrating Delivery Systems, and the enrolling of patients in Medicaid and the State Children’s Health Insurance Program.

HRSA Health Disparities Collaboratives -

Since 1998, the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care has been implementing a series of Health Disparities Collaboratives (HDCs) in Health Centers with the goal of reducing health disparities and overall improved functional and clinical outcomes for Health Center patients.

The Health Disparities Collaboratives are a National effort to achieve strategic system change in the delivery of primary health care. The HDC is an evidence-based quality improvement initiative that started with the Chronic Diseases Care Model, initially focused on the conditions of highest importance to the Health Centers in terms of cost, volume of patient visits, and complexity of care needed. The HDCs have evolved the National Health Center infrastructure to improve the delivery of prevention services, cancer screening and conditions of an acute nature such as oral health as well as business and access collaboratives that improve Health Center operations and patient flow.

HRSA plans to accelerate the dissemination of the lessons learned across all Health Center grantees. Specifically, HRSA is in the process of developing a new set of core clinical measures to assess the quality of care and health outcomes of patients served by the Health Center program.

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Integrating Delivery Systems - For several years, HRSA has been involved with initiatives to encourage Health Centers to integrate functions with other centers and 'safety net' providers in the community to achieve greater efficiency, improve quality of care, and maintain their competitiveness in the managed care marketplace.

HRSA has funded Operational networks/plans through legislation (Section 330(e)(1)(C) of the Public Health Service Act) that was implemented in 2003 to allow for support of operational networks and plans that are at least majority controlled or owned by Health Centers receiving assistance under section 330(e).

Operational networks are defined as Center networks that demonstrate an essential, mission-critical function performed for the members at the network level, enabling the member Centers to perform their business and clinical operations more efficiently and effectively.

Operational networks and plans received support under Section 330(c)(1)(B) or (C) of the Public Health Service Act, as amended, to plan and develop practice management or managed care networks that enable the Centers to (1) reduce costs associated with the provision of health care services; (2) improve access to, and availability of, health care services provided to individuals served by the Centers; (3) enhance the quality and coordination of health care services; or (4) improve the health status of communities.

State Children’s Health Insurance Program (SCHIP) - Health Centers and Primary Care Associations (PCAs) continue to respond to the opportunity to enroll eligible children in SCHIP and children, pregnant women and the elderly in Medicaid. Health Centers served nearly 315,000 enrolled SCHIP patients in CY 2005.

Health Centers are involved in on site outreach and enrollment activities, and PCAs are effective participants in the design of the programs and outreach strategies, training of eligibility workers and development of policies that promote coverage. Many PCAs have made significant contributions to enrolling children in Medicaid and SCHIP and have worked to increase the number of outstationed Medicaid eligibility workers in Health Centers. HRSA is working closely with CMS to further encourage States to outstation eligibility workers at each Federally Qualified Health Center. PCAs have also used the grant funding to leverage other funding that results in greater coverage. In addition, Health Centers have received grants to allow them to hire outreach workers to assist in the enrollment of homeless and migrant children and their families.

Many States have imposed SCHIP enrollment caps, increased premiums, and reduced outreach and enrollment which may reduce future increases in SCHIP. Thus far, we have not seen a significant impact on Health Centers. However, we anticipate that these changes may result in an increase in uninsured children being treated at Health Centers since Centers do not deny care, based on ability to pay. In effect, this could jeopardize the financial viability of Health Centers because Centers will not be compensated for the care that they provide to uninsured children. We will monitor the long-term impact of these changes on Health Centers.

FQHC Look-Alike Program - An FQHC Look-Alike is a Health Center that is determined by the Health Resources and Services Administration to meet the requirements of the section 330 grant program but does not receive the grant. Once a Health Center is designated an FQHC Look-Alike, it is eligible for the following benefits: cost-based reimbursement under Medicaid and Medicare, participation in the 340(b) Federal Drug Pricing program, and automatic Health Professional Shortage Area (HPSA) designation. The enhanced Medicaid and Medicare reimbursement enables the Health Center to improve access to primary care for underinsured and uninsured patients. By participating in the 340(b) Drug Pricing Program, the Health Center can purchase prescription and non-prescription medications for their outpatients at reduced costs. The HPSA status aids Health Centers in their efforts to recruit and retain health professionals.

Rationale for the Budget Request - The FY 2008 Budget of $1,988,467,000 is an increase of $223,751,000 above the FY 2007 CR.

In FY 2008, available funding for the Health Center program will support the development of 222 new access points and 120 expanded medical capacity sites, enabling the Health Center program to eventually increase access to primary health care for an estimated 1.6 million patients.

• FY 2008 is the seventh year of the President’s expansion plan to significantly expand the Health Center safety net by increasing the number of access points and people served. This funding level will support the development of 222 new access points (new starts administered by new grantee organizations and satellites of existing grantees), 120 expanded existing sites, and enable the Health Center program to serve 1.3 million new patients in FY 2008. New access points will be established through Health Centers targeting the neediest populations and communities by replicating existing models of success. Expanded access points will be targeted in communities where an existing Health Center’s ability to provide care falls short of meeting the documented service delivery needs of the uninsured and underserved populations. By significantly expanding the number of existing access points, increased penetration into these populations will be achieved.
  
• Within the total request, at least $26 million will be directed for an initiative to fund Health Centers in poor counties around the Nation that currently lack a health center site. With the FY 2008 requested increase, the President’s Health Center Initiative is on track to meet its goal of increasing access to primary health care in 1,200 communities nationwide through the establishment of new or expanded service delivery sites. However, there is the likelihood that without special attention, some high poverty counties throughout the country may not successfully secure a Health Center site. HRSA in FY 2008 will target up to120 high poverty counties without a Health Center site. The goal of the new initiative is to carry the success of the current initiative further to ensure that every poor county that can support one has a Health Center site. Access to primary and preventive health care services is critical, especially in poor communities that are medically underserved.

The requested level will enable up to 120 new access point grants in poor counties to be awarded. In addition, the level will target a minimum of 25 planning grants to community-based organizations for projects to plan and develop Health Centers in high poverty counties across the country. This support will enable community-based entities to enhance their readiness to implement a health services delivery grant, and in some cases provide an inducement for an organization to address the health care needs of the underserved in a high poverty county where there would otherwise be no expansion activity.

• Federal Tort Claims Act - $44.055 million - Within the FY 2008 request is $44.055 million in no-year funding for payment of FTCA claims reaching settlement and judgment. This level will allow HRSA to pay Health Center FTCA claims during
  FY 2008.
  
  Funding levels for the Health Center program during the last five years reflect this effort and are as follows:

Rationale for the Budget Request - The FY 2007 request of $1,962,861,000 for Health Centers is an increase of $180,553,000 above the FY 2006 appropriation.

Funding levels for the Health Center program during the last five years reflect this effort and are as follows:

In FY 2007, available funding for the Health Center program will support the development of 182 new access points and 120 expanded medical capacity sites, increasing the number of patients served by an estimated 1,200,000 for a total of 15,800,000 patients.

• $180,553,000 - FY 2007 is the sixth year of the President’s expansion plan to significantly expand the Health Center safety net by increasing the number of access points and people served. Approximately $180,553,000 would fund the development of 182 new access points (new starts administered by new grantee organizations and satellites of existing grantees), 120 expanded existing sites, and serve 1,200,000 new patients. New access points will be established through Health Centers targeting the neediest populations and communities by replicating existing models of success. Expanded access points will be targeted in communities where an existing Health Center’s ability to provide care falls short of meeting the documented service delivery needs of the uninsured and underserved populations. By significantly expanding the number of existing access points, increased penetration into these populations will be achieved.
• Within the total request, $52,000,000 will be directed for a new initiative to fund Health Centers in poor counties around the Nation. With the FY 2007 requested increase, the President’s Health Center Initiative is on track to establish or expand 1,200 sites over the 2001 level. However, there is the likelihood that without special attention, some high poverty counties throughout the country may not successfully secure a Health Center site. This new initiative will target 80 high poverty counties without a Health Center site. The goal of the new initiative is to carry the success of the current initiative further to ensure that every poor county that can support one has a Health Center site. Access to primary and preventive health care services is critical, especially in poor communities that are medically underserved.

  The requested level will enable approximately 80 new access points grants in poor counties to be awarded. In addition, the level will fund 50 planning grants to community-based organizations for projects to plan and develop Health Centers in high poverty counties across the country. This support will enable community-based entities to enhance their readiness to implement a health services delivery grant, and in some cases provide an inducement for an organization to address the health care needs of the underserved in a high poverty county where there would otherwise be no expansion activity.

• Federal Tort Claims Act - $44,500,000 - Within the FY 2006 request is $44,500,000 in no-year funding for payment of FTCA claims reaching settlement and judgment. This level will allow HRSA to pay Health Center FTCA claims during FY 2007.

Outputs

* Includes up to 120 New Access Points supported by the High Poverty Counties Initiative

Performance Analysis - The Health Center performance measures are designed to track five areas of program activity critical to monitoring improved access to care and program performance:

1. Population served
2. Infrastructure
3. Preventive services
4. Chronic disease management
5. Productivity and efficiency

Health Centers continue to serve an increasing number of the Nation’s underserved. The number of Health Center patients served in 2005 was 14.1 million, exceeding the target. This increased access beyond the 10.3 million patients served in 2001 represents over a nearly 37 percent increase within a 4-year period. Latest estimates are that the Health Center program will serve approximately 14.8 million patients in 2006. Those numbers are expected to grow to approximately 15 million patients by the end of 2007 and reach 16.3 million by the end of 2008. Over 91 percent of Health Center patients are at or below 200 percent of the Federal poverty level, approximately 64 percent are from racial/ethnic minority groups, and almost 40 percent are uninsured.

Success in increasing the number of patients served is contingent upon the development of new Health Centers, new satellite sites, and expanded capacity of existing clinics. The President’s Health Centers Initiative, which began in FY 2002 has impacted nearly 900 communities through the support of new access points and significantly expanded sites. Health Center expansion has exceeded targeted goals each year of the Presidential Initiative. The 3,831 established comprehensive sites as of FY 2006 represent a growth of 514 sites since 2001. As a result of the Initiative’s investment, the Health Center Program has exceeded projected targets for expanded medical capacity grants each year from 2002 through 2006 resulting in a total of 385 expanded sites. The estimated funding levels for the Health Center Program for Fiscal Years 2007 and 2008 are expected to support a combined total of 342 additional new or expanded access points, of which up to 120 will be supported through a new High Poverty County Initiative commencing in FY 2008.

Critical to Health Center service and improvement in patient health is the provision of comprehensive and preventive health services including pharmacy, preventive dental, mental health, and substance abuse services. As of CY 2005, a substantial percentage of Centers provided these services, with the numbers keeping pace with or exceeding overall Health Center growth. In addition to providing timely and comprehensive health services, Health Centers manage patients with debilitating chronic diseases such as diabetes. Almost 74 percent of Health Center patients with diabetes have had at least one glycohemoglobin test annually, the essential test for managing blood glucose levels.

Health Center low birth weight rates also continue to be lower than National averages for all infants. Historically, as national rates have risen, Health Center rates have also defied National trends, with the Health Center African American low birth weight disparity nearly 40 percent less than observed among all U.S. patients. By addressing health disparities by race, ethnicity, poverty level, and geographic location, Health Centers contribute significantly to the National priority of reducing disparities (Source: Shi L et al Health Services Research 2004).

Having a regular source of primary health care has been shown to have a significant effect on health status disparities. Health Center uninsured patients are far more likely to have a usual and regular source of care than uninsured patients who obtain care elsewhere. Since Health Center patients are far more likely to be from racial/ethnic minority groups, having a regular and usual source of care contributes to the reduction and elimination of disparities in health status (Source: Starfield, B et. al Pediatrics 2004).

Several studies of Medicaid claims for beneficiaries obtaining care at Health Centers compared to elsewhere revealed that the high quality care provided by Health Centers reduces hospitalizations and emergency room use, reduces annual Medicaid costs, and helps prevent more expensive chronic disease and disability among traditionally medically underserved populations. A recent study found that Health Center Medicaid patients are 11 percent less likely to be inappropriately hospitalized and 19 percent less likely to visit the emergency room inappropriately than Medicaid beneficiaries who had another provider as their usual source of care (Sources: Falik M. et al. Med Care 2001, Falik M. et al. J Ambul Care Manage 2006).

A Program Assessment Rating Tool (PART) review of the Health Centers program was conducted during the FY 2004 budget cycle. The program received the highest possible rating of Effective. In fact, the Health Center PART score ranked the program number one in HHS and one of the top ten programs in all of government. In response to PART recommendations, the program continues to collaborate with other programs and agencies that share a common goal to improve health outcomes.

SOURCES OF REVENUE FOR HEALTH CENTERS
(In millions of dollars)

1/ Excludes funding for Tort Claims: FY 2006 - $44.5 million, FY 2007 - $26.9 million and FY 2008 - $44.05 million.

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