We at the North Star Policy Institute strive to provide quality and thorough analyses of major policy conversations. In today’s contentious health care environment, policy changes, proposals, and critiques quickly flood the conversation, and they can turn into overly-wonky, exhausting jargon pits. Keeping this in mind, we will produce a series of articles that explain much of the jargon and contextualize it so all Minnesotans can engage in such an incredibly important discussion. First up in this series: health centers.
Minnesota has a vast network of health centers with the mission of caring for people facing sizable barriers to care. They include Federally Qualified Health Centers (FQHCs), FQHC Lookalikes, Rural Health Clinics, Indian Health Service Facilities, Veteran’s Health Facilities, and National Health Service Corps (NHSC) Sites. These health centers are a vital segment of the “safety net,” addressing inequities in care, geographic barriers, as well as serving anybody in a community regardless of their ability to pay for care. FQHCs, for example, are required to have a governing board made up primarily of current patients, and should reflect the demographic makeup of the communities the clinic serves. These centers serve over 170,000 people in Minnesota annually, and over 25 million Americans each year.
Demographically, Minnesotans who use FQHCs are ethnically diverse, with white, black, and Hispanic/Latinx people each making up between 25% to 33% of the population. Roughly one in four patients is a child, and another 10% are seniors. Additionally, 30% of patients are best served in a language other than English. Nearly every FQHC patient in Minnesota earns less than 200% of the Federal Poverty Level ($24,600 for a family of four), and almost 70% of patients earn under 100% of the Federal Poverty Level. This information is available at the HRSA website, at the state, national, or organizational level.
Minnesota has 16 organizations that operate at least one FQHC site. There is an additional organization that operates 1 FQHC Lookalike. These organizations range from a single primary care and dental facility to networks that span primary care, dental, vision, shelters for the homeless and battered women, walk-in sites, mobile sites, mental health, social work, and other services. These organizations can be publicly run, non-profit organizations, or for-profit organizations, but they all must serve medically underserved people regardless of their ability to pay. In total, there are 81 health care delivery sites in Minnesota, per Kaiser. These organizations, by law, must provide a “sliding fee scale” for people without insurance. This scale is usually a small nominal fee, between two and 20 dollars, depending on income levels, which is meant to offset some of the costs of care and act as a deterrent from overusing care (much like a copay and deductible do for those with insurance). If the person can’t pay the small nominal fee, that person’s care is at the discretion of the organization, which will often reach an arrangement so a physician or nurse can see the patient.
Health centers that qualify as FQHCs are eligible for several grants and benefits. Benefits offered to all FQHCs and Lookalikes are prospective Medicare and Medicaid reimbursement payments, discounted pharmaceuticals, free vaccines for uninsured children, and the ability to recruit primary care providers through the National Health Service Corps (a federal loan forgiveness program for providers working in underserved areas). Only FQHCs are eligible for additional grants to serve vulnerable populations, including the homeless, migrants, and public housing residents. FQHCs are also eligible for capital improvement grants and federally provided medical malpractice insurance. Many of these grants are also available to Rural Health Clinics. FQHC funding grants are quite competitive (there are 1,367 organizations nationwide that won a HRSA grant last year), so existing FQHC Lookalikes that try to apply for an updated status can be rejected.
In Minnesota, the largest FQHC organization is West Side Community Health Services, which served 35,656 Minnesotans in 2016. Other large FQHCs include the Hennepin County Department of Primary Care, the University of Minnesota, United Family Practice Health Center in St. Paul, Cook Area Health Services, and Lake Superior Community Health Center in Duluth. A map of FQHCs in Minnesota and a close-up of the metro area (via UDS Mapper) shows the scope of these vital programs.
Hopefully, this article provided some insight into the types of clinics and organizations that provide primary care to those most in need in Minnesota. Next week, we will review the basics of health insurance, the history of public insurance in America pre-Affordable Care Act, and explain how those programs shaped the safety net in Minnesota.