How to Start a CHC

What is a Community Health Center?
Community Health Centers (CHCs), also called a Federally Qualified Health Center or FQHC, are federally designated and:

• Serve all patients regardless of ability to pay
• Are located in medically underserved communities or populations
• Provide comprehensive health care, including access to dental and mental health services
• Are run by community boards
• Are community-based nonprofits or public agencies with a mission to provide health care to low-income, working families

CHCs have been around for more than 50 years. Since the establishment of the Health Center Program in 1965, bipartisan Congressional support has helped to maintain and strengthen the program.

There isn’t enough access to health care in my community. How do I start a CHC?
The road is long and many requirements must be met to receive and maintain designation as a CHC.

The Health Center Program is overseen by the Bureau of Primary Health Care (BPHC), under the Health Services Administration (HRSA) within the U.S. Department of Health and Human Services (HHS). Funding, designation, and regulation of CHCs are all managed by BPHC. Further information on the governance of the Health Center Program and BPHC is available here.

Should my community pursue the CHC model?
All CHCs must meet the core tenets of the designation and comply with the Health Center Program Requirements, as outlined in the Health Center Compliance Manual. However, there are two paths to becoming a CHC – through a competitive grant application or the Look-Alike designation:

• CHC grantees – Receive grant funding from the Federal government through section 330 of the Public Health Service (PHS) Act and are eligible for malpractice coverage through the Federal Torts Claims Act (FTCA). New CHC grantees are awarded when there is a New Access Point (NAP) grant opportunity. It is unclear when the next NAP will be available.
• Look-Alikes – Do not receive funding via a Federal grant and are not eligible for FTCA coverage, but do receive many of the same benefits as CHC grantees. This model is often pursued because the competitive grant opportunities to become a newly funded CHC via a NAP is infrequent. More on the Look-Alike model is found here.

CHC grantees and Look-Alikes both receive cost-based reimbursement from Medicaid and Medicare, are eligible to access prescription medications at a reduced cost through the 340B Drug Pricing Program, have access to free vaccines for children who are uninsured or underinsured through the Vaccines for Children Program, and can use the National Health Service Corps (NHSC) loan forgiveness program to recruit and retain primary care providers.

How do I determine if there is not enough access to health care in my community?
Communities should determine where there are gaps in access to health care 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 is one step closer to determining if the CHC model fits the needs of the community.

To qualify to become either a CHC grantee or Look-Alike, 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 (PCO), within the Health Access Branch of the Colorado Department of Public Health and Environment. For the guidelines and definitions for qualifying to become an MUA/P, see the Bureau of Health Professions MUA/P Guidelines.

In addition to the MUA/P designation, the application for CHC designation must demonstrate high level of unmet health care needs, as illustrated through particular measures related to mortality and morbidity, health care access, and health behaviors. CCHN’s Resources and Data page has links to several sources for this information.

What services are CHCs required to provide?
The scope of services provided at CHCs is comprehensive. CHCs are required to provide access, either directly or via contract or referral arrangement to primary, dental, and behavioral health care. All of the services must be available to patients regardless of ability to pay, with sliding fee discounts available for patients under 200% of the Federal Poverty Level based only on their income and family size.

These required services include, but are not limited to, providing access to the following types of services: diagnostic screenings, laboratory, radiology, prenatal and perinatal care, case management, voluntary family planning, and pharmacy. As well, CHCs are required to maintain collaborative arrangements that allow for hospital admitting privileges and referrals to specialty care.

All services must be provided in a culturally competent manner, with access to interpretation or translation services for patients with limited English-speaking ability. See BPHC’s webpage on Scope of Project for more information on the service provided at CHCs.

Why is it important that the community is involved in considering the CHC model?
The community must be engaged from the start, through the application process, and beyond – not only is this at the heart of the CHC model, but it is also part of the Health Center Program Requirements.

From the beginning, the community should be involved in the discussions about starting a CHC, help to develop partnerships and collaborations that will make the CHC viable, and encourage other community members to utilize a new CHC.

Once a CHC is established, the community engagement does not end. There is continued emphasis on collaboration and partnership within the community. As well, a key tenet of the CHC model is that every CHCs has a patient or consumer majority on the Board of Directors (at least 51% of the Board of Directors must be users of the CHC) and that remaining board members come from the community.

Are there any resources that can help me learn more?

• Check out CCHN’s Resources and Data page
• So You Want to Start a Health Center (2015): A practical guide for starting a CHC, developed by the National Association of Community Health Centers (NACHC). Click here to access this guide.

To further explore if the CHC model is right for your community and to find out more about the application process, please contact:

Suzanne Smith, Health Center Operations Division Director