History

Health Centers funded by the federal government are known as Federally Qualified Health Centers, or FQHCs. The earliest federally-funded Centers in Indiana were Citizens Health Center in Indianapolis, developed as part of the War on Poverty, and Indiana Health Centers, Inc., which initially served a seasonal and migrant farm worker population.  HealthNet in Indianapolis soon followed. 

While the FQHC program grew nationally, for reasons we can only speculate on there were just four Indiana FQHCs until the 1990s. It is presumed that in the early years, Indiana was politically reluctant to pursue federal funding; in addition, through the early '90s little federal funding was available to start new Centers.

As a corporation, Indiana Health Centers, Inc. grew to include not only migrant farm worker sites, but also Community Health Center (CHC) sites in multiple communities. In the early '90s, two sites in Evansville received federal funding - Washington Avenue Community Health Center and ECHO Health Center, a CHC for the homeless.  They merged to form a new ECHO, which continues to serve both homeless and community members at three sites.

State support for the development of CHCs in Indiana began in 1995.  The Indiana General Assembly appropriated $2 million over the biennium (two-year period) for the development of non-profit community-based primary health care centers in medically underserved parts of the state.  This legislation was the culmination of several years of conversations by the Indiana Primary Health Care Association (IPHCA) and its members with Legislators about the need to improve access to primary health care services throughout the state.

During 1995, staff from IPHCA and the Indiana State Department of Health (ISDH) worked closely together to establish criteria for Health Centers.  At the end of the first year of state funding, Joni Albright, ISDH Assistant Commissioner, reported to the General Assembly State Budget Committee that six implementation awards and three planning awards had been made to community groups during the year.  At that time, recommendations were made for four additional implementation grants, as well as two implementation grants for two planning grantees from the first year. A contract with IPHCA for technical assistance to all grantees was part of the package.

In the second year of the biennium, Urban Care Center in St Joseph County, Jennings/Ripley County, Johnson Memorial Hospital, and ECHO were added to the funding list.

The 1995-1996 Biennium Grantees

Important precedents were established during the first biennium.  The federal FQHC program was used as a model for Indiana State-Funded Community Health Centers, and threshold requirements for applicants included (but were not limited) to:

• Non-profit entity in an area with a shortage designation, or the ability to demonstrate need;
• Board of Directors with minimum 30% users of the Health Center services;
• Open to all regardless of ability to pay, and sliding fee scale adopted / posted;
• Health Center open during extended hours;
• Comprehensively serving all ages and genders; and
• Having at least one full-time provider 32 hours per week, and a physician with hospital admitting privileges.

IPHCA and ISDH worked to make the grant and award process open and equitable.  Requests for Proposals were distributed, an applicant's workshop was given, and hours of technical assistance were provided.

The planning efforts were successful and seven of the biennium's grantees, who had not previously been federally funded, are now established FQHCs.

In 1997, funding allocated by the General Assembly for the biennium grew to $10 million, with $1 million reserved for capital expenditures.  Nine additional communities received implementation / operating funds, and eight communities received planning grants. Four Health Centers received capital awards. With Indiana's participation in the tobacco settlement fund, the Indiana Legislators were able to move the Health Center program from the state's general fund to the tobacco settlement program.  In 2000, an additional $10 million was made available to Health Centers for capital expenditures, and 10 Health Centers received between $89,250 and $1 million in capital dollars.

In 2006, 42 organizations benefited from the tobacco settlement funds.  In addition, more Community Health Centers have been able to meet federal program expectations and compete for federal dollars. Seven additional corporations have received federal funding.  Three additional communities were notified recently that they have been awarded federal planning grants to examine the communities' need and interest in developing an application for FQHC funding.

In 2007, funding for Health Centers doubled, from $15 million a year to $30 million a year, with the stipulation that a portion of the money could be utilized for capital expenditures.

In looking back over this history, it is clear that state funding in Indiana has acted as a powerful incubator program for Health Center growth.