How To Start A CHC

There isn’t enough access to health care in my community, how do I start a Community Health Center?

The road is long when looking at applying to become a Community Health Center (CHC). The following information describes the main requirements of CHCs as well as information about the funded CHC model versus the Look-Alike model.

CHCs provide services to all with charges based on ability to pay and a focus on the medically underserved.  There are CHCs that provide services to the general community and CHCs focused on special populations such as homeless or migrant and seasonal farmworkers.  There is both a funded model and a Look-Alike model.  And outside of the CHC model, there are Rural Health Clinics, community funded clinics, Coalitions, and Referral Networks.

Communities should determine where there are gaps in access and whether or not the gaps are related to specific populations, specific areas of the community, specific health care services, etc.  A community health needs assessment should be done to help identify these gaps.  Once the gaps are identified, the community will be able to determine what model of care will address the community needs.

The Look-Alike model may be a better fit for your community.  

If you are a clinic that is operational and already providing services similar to those of CHCs, it may be beneficial to apply for Look-Alike status while waiting for a Federal CHC funding opportunity to occur.  The major difference between funded CHCs and Look-Alikes are that funded CHCs receive grant funding from the Federal government through section 330 of the Public Health Service (PHS) Act to provide services to uninsured users.  Although Look-Alike entities are not funded, they are able to receive many of the same benefits as funded grantees, including an enhanced Medicaid reimbursement rate, reimbursement under Medicare for the “first dollar” of services, and eligibility to purchase prescription and non-prescription medications at reduced cost through the 340B Drug Pricing Program. For more about the Look-Alike model, and how it compares to the section 330 CHC model, click here.

CHCs provide comprehensive primary care.

The scope of services provided at CHCs is comprehensive.  CHCs are required to provide for the following:

    1. Basic Health Services

– Health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate,
physician assistants, nurse practitioners, and nurse midwives;
– Diagnostic laboratory and radiology services;
– Preventive health services, including:
– Prenatal and perinatal services;
– Screening for breast and cervical cancer;
– Well-child services;
– Immunizations against vaccine-preventable diseases;
– Screenings for elevated blood lead levels, communicable diseases, and cholesterol;
– Pediatric eye, ear, and dental screenings to determine the need for vision and hearing correction and dental care;
– Voluntary family planning services;
– Preventive dental services;
– Hospital and specialty care arrangements and/or referrals
– Emergency medical services;
– After Hours Care (e.g. providing professional coverage via a call-in center);
– Pharmaceutical services as may be appropriate for particular centers

  1. Referrals to providers of medical services and other health–related services (including substance abuse and mental health services);
  2. Patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, educational, or other related services;
  3. Services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals);
  4. Education of patients and the general population served by the health center regarding the availability and proper use of health services.


For additional information on Federal rules and regulations click here.

The need must be great.
In order to qualify to become either a funded or Look-Alike CHC, applicants must propose to serve in whole or in part a federally designated Medically Underserved Area or Population (MUA/P).  For more information on the MUA/P designation, contact the Colorado Primary Care Office.  For the guidelines and definitions for qualifying to become a MUA/P, see the Bureau of Health Professions MUA/P Guidelines.

In addition to the MUA/P designation, the community must score a 70 or more on the Need for Assistance (NFA) worksheet.  The NFA guidelines and worksheet are Forms 9 A & B of the most recent New Access Point application guidance found on the Bureau of Primary Health Care Web site.  The NFA worksheet is a measure of the health care need in a defined community.  In order to submit an application to become a CHC, the applicant must score 70 or above.  A score less than 70 will not be considered for designation.

The community is involved at every step.

The community must be engaged from the start, through the application process, and beyond.  The community should be involved in the discussions about starting a CHC, help to develop partnerships and collaborations that will make a health center viable, and encourage other community members to utilize a new CHC.  Once a CHC is established, the community engagement does not end. This is because one of the features of the CHC model, which sets it apart from others, is that CHCs have a patient or consumer majority on the Board of Directors (at least 51% of the Board of Directors must be users of the CHC).

CCHN is a source of support in this process.

The CHC model is complex and the application process lengthy.  To further explore if the CHC model is right for your community and to find out more about the application process you should contact Suzanne Smith, the Health Center Data and Operations Manager at CCHN, via email or phone at (303) 861-5165, ext. 234.  CCHN is an important asset to you in this process.

Other Helpful Documents

  • Community Development Guidebook: Developed by CCHN, this guide was created to aide individuals and communities in understanding the CHC model and application process. To obtain a copy of the Community Development Guidebook, please contact  Suzanne Smith.
  • So You Want to Start a Health Center:  A practical guide for starting a CHC, developed by the National Association of Community Health Centers (NACHC). Click here to access this guide.
  • Successful Practices in Community Development for Health Centers: a guide developed by NACHC to provide suggestions on how to proceed with a community interested in starting a health center. Click here to access this guide.
  • Funded! Now What?: A guide for newly funded CHCs from NACHC. Click here to access this guide.