What Is a Community Health Center (CHC)?

Community Health Centers (CHCs) – many funded through the Bureau of Primary Health Care (BPHC), part of the US Department of Health and Human Services – 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 1,000 Health Centers; across the US, Health Centers serve 16 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 drugs at reduced prices

In Indiana, there are also State-Funded Health Centers, which receive operating monies from tobacco settlement funds received by the state.  All but one of Indiana's 18 Federally Qualified Health Centers also receive state money; in addition, there are 29 Centers in Indiana that receive only state funding.

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. In addition, 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:

Accessibility
Accountability
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"
Serve homeless adults, families, and children
(8.7 % of total program appropriation)

Section 330 (i) – "Public Housing Health Centers"
Serve residents of public housing
(1.2 % of total program appropriation)

Indiana's Health Centers

Indiana has 47 Community Health Centers, of which 18 are currently Federally Qualified Health Centers (FQHCs); 29 Centers receive state funding only.  Together, these 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.