How To Start A CHC

There isn’t enough access to health care in my community. Is a Community Health Center (CHC) a good fit for my community? How do I start a CHC?

The road is long and there are many requirements that must be met to receive and maintain designation as a CHC, also called a Federally Qualified Health Center or FQHC.

CHCs provide services to all patients regardless of ability to pay, 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. Outside of the CHC model, there are designated Rural Health Clinics, community-funded clinics, community coalitions, and referral networks.

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 is all managed by BPHC. Further information on the governance of the Health Center Program and BPHC is found here.

Should my community pursue the CHC grantee or Look-Alike 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).
  • 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 New Access Point (NAP) grant are 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) 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). This map of Colorado can help determine if the community is already part of an existing MUA/P. For more information on the MUA/P designation in general, 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 a MUA/P, see the Bureau of Health Professions MUA/P Guidelines.

In addition to the MUA/P designation, the application for funding or Look-Alike designation must demonstrate a high level of unmet health care needs, as illustrated through particular measures related to mortality and morbidity, health care access, and health behaviors. In partnership with the PCO, CCHN created this resource on county-level core health indicators and identified access barriers that are often used in applications for funding or Look-Alike designation.

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 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.

BPHC prepared this resource on Service Descriptors that walks through each type of required and additional service for a CHC. All services must be provided in a culturally competent manner, with access to interpretation or translation services for patients with limited English-speaking ability.

Why is it important that 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, it is also part of the Health Center Program Requirements.

  • At the start, 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).

Are there any resources that can help me learn more?

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

Other resources:

  • Check out CCHN’s Resources and Data page and CHC Resource Center
  • So You Want to Start a Health Center (July 2011): A practical guide for starting a CHC, developed by the National Association of Community Health Centers (NACHC). Click here to access this guide.