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Focus on Quality Transformation webinar series

Part 1: Medical Legal Partnership 101

Quarterly Claims and Operations Meeting

Part 2: Medical Legal Partnership Funding/Screening

Part 3 Medical Legal Partnership Immigrants and Healthcare

History of CHCs in Indiana
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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.

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.

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.

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.

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 2009, the funding for Community Health Centers increased, from $15 million per year to $17.5 million the first year and $20 million the second year of the biennium.

In 2010, President Obama signed the Patient Protection and Affordable Care Act and the Healthcare and Education Reconciliation Act of 2010. Both bills dramatically reformed health care in the United States by allowing individuals to obtain affordable health care coverage over the course of the next several years.

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.