Community Health Centers have experienced significant growth since the enactment of the The Affordable Care Act (ACA), which expanded coverage options for many low-income health center patients, and provided increased funding for health centers through the Community Health Center Fund (CHCF).
Community Health Centers play an essential role in the implementation of the ACA. The community health center model also overcomes geographic, cultural, linguistic and other barriers through a team‐based approach to care that includes physicians, nurse practitioners, physician assistants, nurses, dental providers, midwives, behavioral health care providers, social workers, health educators, and many others.
The Effects of Medicaid Expansion under the ACA
Coverage: Studies show that Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates, among the low-income population broadly and within specific vulnerable populations. States that implemented the expansion through a waiver have seen coverage gains, but some waiver provisions appear to compromise coverage. Data do not support a relationship between states’ expansion status and community-based services waiver waiting lists.
Access to care, utilization, affordability, and health outcomes: Most research demonstrates that Medicaid expansion has positively affected access to care, utilization of services, the affordability of care, and financial security among the low-income population. However, findings on provider capacity were mixed, with some studies suggesting that provider shortages are a challenge in certain contexts. Studies show improved self-reported health following expansion, and multiple new studies demonstrate a positive association between expansion and health outcomes. Further research is needed to more fully determine effects on outcomes given that it may take additional time for measurable changes in health outcomes to occur.
Economic measures: Analyses find positive effects of expansion on numerous economic outcomes, despite Medicaid enrollment growth initially exceeding projections in many states. Total (federal and state) Medicaid spending increased following expansion implementation, but research suggests that there were no significant increases in state spending from state funds as a result of the expansion through 2015 (although an uptick in state Medicaid spending growth was projected for 2017 and later years as the federal share for the expansion population phases down from 100% to 90%). Studies also show that Medicaid expansions result in reductions in uncompensated care costs for hospitals and clinics as well as positive or neutral effects on employment and the labor market.
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