An Overview of Community Health Centers and FQHCs: History & Today’s Challenges

Salud Para La Gente is a community health center. The genesis of community health centers can be traced to the civil rights movement of the 1960s and President Lyndon Johnson's war on poverty. The Civil Rights Act had not been passed yet and the disparate treatment of people of color was highlighted by Martin Luther King Jr. and later, by César Chavez.

  
The Pajaro Valley and Migrant Farm Labor

The Pajaro Valley is one of the richest farming valleys in the world. Accordingly, there exists a large migrant population whose presence is necessary to plant and harvest the abundance of lettuce, strawberries, raspberries, broccoli and nursery crops. Migrant farm labor supports the 28 billion dollar fruit and vegetable industry in the U.S., 85% of which are hand-harvested and/or cultivated. Without this large work force, the farmers in the Pajaro Valley could not survive. The farmers require not only an available workforce, but a healthy one.

There are estimated to be as many as 4 million migratory, seasonal farm workers in the United States, comprised of a variety of races and cultures. Often the migrant family is besieged and weakened by sporadic unemployment and loss of extended family support systems. Because income may be irregular and often falls below the national poverty level, a considerable amount of insecurity exists regarding food, clothing, shelter, transportation, health care and other essentials. Exposure to pesticides and infectious diseases, and life in crowded, substandard housing place the migrant population at high risk for a multitude of complex health problems.

The Migrant Health Act of 1962

In an effort to address this problem, President John F. Kennedy signed into law the Migrant Health Act of 1962. This law established the authorization for delivery of primary and supplemental health services to migrant farm workers and provided federally funded health care services in medically underserved areas throughout the United States and its territories. Grants were given to over 120 community based and state organizations to facilitate comprehensive medical care services with a culturally sensitive focus on migrant and seasonal farm workers and their families. This program not only to serves this special needs population, but also protects farm community residents from prevalent communicable diseases and assists the often overburdened rural health care systems.

The health center model that emerged targeted the roots of poverty by combining the resources of local communities with federal funds to establish neighborhood clinics in both rural and urban areas around America. It was a formula that not only empowered communities, but also generated compelling proof that affordable and accessible health care produced compounding benefits. Studies show that the health center model has reduced health disparities, lowered infant mortality rates, and reduced chronic disease. Health centers create local jobs and other investments in hard-pressed communities, and produce cost-savings for the health care system by reducing the need for acute care at hospital emergency rooms.

Federally Qualified Health Centers (FQHCs)

In 1990 the Omnibus Budget Reconciliation Act amended the Social Security Act and, effective in 1991, added Federally Qualified Health Centers (FQHCs) as a benefit under Medicare. FQHCs are “safety net” providers such as community health centers, public housing centers, and outpatient health programs. The primary purpose of the FQHC program is to enhance primary care services in underserved urban and rural communities.

Salud Para La Gente has been designated a FQHC, and as such, Salud receives grant funding under Section 330 of the Public Health Service Act. FQHCs are highly regulated by federal statute, regulation and administrative directives and must meet high federal standards for delivery of quality care. These services generally include comprehensive primary care provided by physicians, nurse practitioners, physician assistants, certified nurse midwives, and other clinicians. FQHCs operate under a particular federal reimbursement system for their services.

Salud provides comprehensive primary health care for the entire family, currently including medical, dental, eye care services and adult day care. Medical providers at Salud include physicians practicing internal medicine, obstetrics and gynecology, pediatrics, and family practice/family medicine. A complete listing and description of Salud’s service areas, costs and insurance options, and listing of providers can be found elsewhere on this web site.

FQHCs must provide services to persons of all ages, regardless of ability to pay. Nationwide, and at Salud, FQHCs bring primary health care to underserved/underinsured/uninsured patients, including migrant workers and non-U.S. citizens. Services must be culturally and linguistically appropriate for the diverse populations which are served. FQHCs must thoroughly understand the community needs and resources in their area in order to best serve the population, and in order to comply with federal expectations. They must also conduct continuous quality improvement and performance measurements to achieve excellence in their delivery of health care.

In 2008 community health centers served 18 million people across America. Salud alone had over 102,600 patient encounters in 2008.

The Local Safety Net

Consistent with its mission and duties as an FQHC, Salud collaborates with other safety net providers in the local area in order to provide the best care to the uninsured and underserved. These local safety net providers include the County of Santa Cruz clinics, Dientes Community Dental Care, Santa Cruz Women’s Health Center, Planned Parenthood. Salud is also active in collaborative organizations and initiatives with these groups, including the Health Improvement Partnership, the Safety Net Clinic Coalition, the Oral Health Collaborative, and the Dental Affinity Program, to name only a few.

The Budget Challenges

As I write this column Salud and all community health centers including FQHCs in California are experiencing extreme challenges as the California budget debacle worsens almost on a daily basis. As part of the February 2009 budget deal reached between the Governor and the legislature, adult Medi-Cal optional benefits have been eliminated, meaning that Medi-Cal reimbursement is no longer available to adults for dental and optometric services (both of which Salud provides), nor for chiropractic care, incontinence creams and washes, acupuncture, audiology, podiatry, speech therapy and psychology services.

The Governor has proposed elimination of numerous other reimbursement systems and programs, including Healthy Families (which would mean over 6300 children in Santa Cruz County alone would lose medical insurance coverage), Expanded Access to Primary Care (EAPC), and seasonal and migrant worker funding. He has also proposed wholesale elimination of Medi-Cal adult day health centers throughout the state. This means that 36,000 participants statewide would lose their access to adult day health care. Salud’s program, Elderday, had 19,300 participant encounters in 2008. The cumulative impact of the elimination of these funding sources and programs in devastating to the community health centers and safety net providers, be they FQHCs or not.

Salud’s Commitment to Service

Whatever the outcome of the dialogue between the Governor and the legislature, Salud remains committed to ensuring that it delivers the best possible care to the underserved populations in its area.

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For further information on what Salud is doing to effect change in Sacramento, and for information on what you can do to help, contact Salud’s Director of Advocacy, Community Engagement & Media Relations, Sara Clarenbach, at (831) 728-8250 or at sclarenbach@splg.org