Community health centers in Medicaid-expansion states report they have more resources to provide behavioral health and social services, are more financially stable and more likely to adopt innovative payment policies than those in non-expansion states, according to a new survey released Thursday.
The Commonwealth Fund found 76% of Federally Qualified Health Centers (FQHCs) in Medicaid-expansion states had improved financial capability to provide affordable care to patients since the ACA has taken effect, compared to 52% of providers in non-expansion states.
Community health centers in expansion states were also more likely to participate in value-based pay models, with 79% of providers in those states reporting they or their clinicians received financial incentives for hitting care quality targets compared to 69% of FQHCs in non-expansion states.
Community health centers in Medicaid-expansion states were more likely to address non-clinical social factors that can negatively impact patient health outcomes and coordinate with community social services.
"With Medicaid expansion not only did more people gain insurance but it made it easier for the community health centers because they can actually get paid for the services that they provide," said Melinda Abrams, study co-author and vice president and director at the Commonwealth Fund. "This offers not only financial stability, but increases their ability to hire new staff, invest in better care, and adopting new models that could potentially lower costs."
The majority of FQHCs in both expansion and non-expansion states were likely to offer short-term counseling for patients with behavioral healthcare needs. But providers in expansion states were more likely to offer treatment for substance use disorder, an underserved need that has only grown in light of the opioid epidemic in recent years.
Approximately 44% of expansion state FQHCs provided medication-assisted treatment compared to 25% of those in non-expansion states. Such figures are similar to other research that has suggested Medicaid expansion help to increase access to opioid addiction treatment.
Abrams said that increased availability was probably a factor in why providers in expansion states were more likely to report having unfilled job positions for mental health and social service staff. She surmised it was a combination of more job opportunities becoming available coupled with the difficulty of hiring trained behavioral health and social service professionals.
The role Medicaid expansion has played toward increasing both the level of access as well as the scope of health services offered by the country's more than 1,300 FQHCs has been well documented since its implementation in 2014.
Many community health centers experienced extensive growth from funding during both the George W. Bush and Obama administrations. The latter's Community Health Center Fund from the Affordable Care Act has been credited with opening 950 community health center sites since 2010.
More than 28 million patients receive care at more than 11,000 sites, according to the National Association of Community Health Centers. Community health centers are the primary healthcare provider for the medically underserved, with 84% of their patients earning incomes at levels that would qualify them for Medicaid under the expansion. Such facilities offer services to patients regardless of their ability to pay.
Abrams said the survey's results helped to highlight the importance Medicaid expansion has played in supporting the country's healthcare safety net. She said actions taken by the Trump administration last month to support a federal judge's ruling against the Affordable Care Act would have devastating consequences for both economically vulnerable patients and community health centers.
"It will be much harder for them to continue to improve and meet the needs of their patient population," Abrams said.
At the time of the survey in September 2018, 31 states and the District of Columbia had expanded Medicaid. Now , the total is up to 37, according to the Kaiser Family Foundation.
