Indiana has State-Funded Community Health Centers, which receive
operating monies from tobacco settlement funds received by the state,
and Federally Qualified Health Centers (FQHC). The FQHCs are funded
primarily through the Bureau of Primary Health Care (BPHC), part of the
US Department of Health and Human Services, and they may also receive
state money from the tobacco settlement. In total, there are 48
Community Health Centers in Indiana, 19 of which are FQHCs.
Community Health Centers (CHCs) are a major component of America's
health care safety net, providing high quality primary health care to
low-income citizens, the uninsured, and other vulnerable populations.
The BPHC funds more than 1,200 Health Centers. Across the US, Health
Centers serve 18 million people.
"Health Centers" is actually an all-encompassing term for a spectrum of
public, not-for-profit organizations and programs. Those receiving
Federal funding through BPHC under Section 330 of the Public Health
Service Act (as amended by the Health Centers Consolidated Act of 1996
and the Safety Net Amendments of 2002), are called Federally Qualified
Health Centers, or FQHCs. These include Community Health Centers,
Migrant Health Centers, Health Care for the Homeless Health Centers, and
Primary Care Public Housing Health Centers. Among other benefits, FQHCs
have access to special medical malpractice insurance through the
Federal Tort Claims Act.
Other organizations meet FQHC requirements but do not receive
Federal funding. These are known as Federally Qualified Health Center
Look-Alikes (FQHCLAs). Like FQHCs, FQHCLAs are eligible to receive
enhanced reimbursement from Medicare and Medicaid and to participate in
the 340B Program through which they can purchase medications at reduced
Background: Primary Health Care
The World Health Organization (WHO) defines "primary health
care" as both a level of health service delivery and an approach to
health care practice. Primary care is the basis of a health system that
provides initial care, as well as many other needed health services, to
a person or population through a primary care provider.
Core principles of primary care are that services must include accessible, comprehensive, continuous, and coordinated personal care, delivered in the context of family and community. Primary health care should be available to all people without regard for barriers of geography, cost, language, or culture. Services should include care for acute problems, injuries, and chronic diseases; in addition, preventive care services (including health education) must be provided. Finally, primary health services for individual clients should involve an understanding of emotional and social factors in assessment and intervention.
Primary health care encompasses all life cycles and consists of five major components:
- Comprehensiveness of Care
- Coordination / Continuity of Care
- Health Promotion / Disease Prevention
Providers can be physicians, nurses, dentists, hygienists or
other health professionals trained and credentialed specifically for
primary care. Clinicians coordinate care for patients among various
health professionals and for multiple patient concerns, responding to
the multiplicity of problems faced by most patients. Coordination is
achieved through an approach known as "continuity of care", defined by
the ongoing relationship between individual patients and primary care
clinicians who are committed to the person (not a specific disease) and
who recognize that physical, mental, emotional, and social concerns are
interrelated. Primary care clinicians discuss ongoing care with the
individual, recognizing that health is greatly influenced by family,
culture, and community.
Health Center Fundamentals
Community Health Centers are characterized by five essential elements that differentiate them from other providers:
- They must be located in or serve a documented high-need
community. Designations, each with its own specific criteria, include
Medically Underserved Areas (MUAs), Medically Underserved Populations
(MUPs), and Health Professional Shortage Areas (HPSAs).
- They must provide comprehensive primary care services, as
well as supportive / enabling services such as translation and
transportation that promote access to care;
- Their services must be available to all residents of their
service areas regardless of income status, with fees formally adjusted
for patients' ability to pay;
- They must be governed by a Community Board that includes a majority of members who are Center patients ("consumers"); and,
- They must meet specific performance and accountability requirements for administrative, clinical, and financial operations.
Four types of Health Centers are funded under Section 330 of the
Public Health Service Act. Each type is required by statute to receive a
certain portion of the total program appropriation.
Section 330 (e) – "Community Health Centers"
Serve medically under-served and low income people; includes Centers delivering care through school-based sites
(81.5% of total program appropriation)
Section 330 (g) – "Migrant Health Centers"
Serve migrant and seasonal agricultural workers and their families
(8.6 % of total program appropriation)
Section 330 (h) – "Homeless Health Centers"
Section 330 (i) – "Public Housing Health Centers "
Serve homeless adults, families, and children
(8.7 % of total program appropriation)
Serve residents of public housing
(1.2 % of total program appropriation)
Indiana's Health Centers
The 48 Indiana Community Health Centers serve as "health care
homes" for residents in more than 50 of the 92 counties in Indiana.
The Centers are public or private not-for-profit organizations that
provide some or all of the following services depending on the need and
support within the specific local Indiana community:
- Primary medical care
- Diagnostic laboratory and radiological services
- Preventive services including: prenatal and perinatal
services, cancer and other disease screenings, well child services,
immunizations against vaccine-preventable diseases, screenings for
elevated blood lead levels, cholesterol testing, etc.
- Eye, ear and dental screening for children
- Voluntary family planning services
- Preventive dental services
- Emergency medical services
- Pharmaceutical services as appropriate to the particular Center
- Referrals to other providers of medical and health-related services including substance abuse and mental health services
- Patient case management services, including referral,
follow-up, and eligibility assessment for and gaining access to Federal,
State, and local support and financial programs for various medical,
social, and related services
- Enabling services including outreach, transportation, translation, etc.
- Education about health services availability and appropriate use.
Indiana 's CHCs set their hours of operation to accommodate local community needs.