Federally Qualified Health Centers (FQHCs)
If you are looking for a Federally-supported Health Center and other health centers in a rural area, you can search by address, state, county and ZIP code at Find a Health Center.
Health centers are important safety net providers in rural areas. Of the over 22 million Americans who receive care from health centers, approximately a third are rural residents, according to America’s Health Centers. In order to qualify for federal support as a health center, an organization must:
- Offer services to all persons, regardless of the person’s ability to pay
- Establish a sliding fee discount program
- Be a nonprofit or public organization
- Be community-based, with the majority of their governing board of directors composed of their patients
- Serve a medically underserved area or population
- Provide comprehensive primary care services
- Have an ongoing quality assurance program
There are numerous definitions and distinctions that should be understood related to health centers, including:
- Health Center Program Grantee: Health centers that receive grant funding from the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care, under the Health Center Program, as authorized by Section 330 of the Public Health Service Act. Most grants are funded to serve an entire community, while others are funded to target specific populations, such as migrants, persons experiencing homelessness, and residents of public housing.
- Federal Qualified Health Center (FQHC): FQHCs are outpatient clinics that qualify for specific reimbursement systems under Medicare and Medicaid. FQHCs include federally-supported health centers (both grantees and Look-Alikes) as well as certain outpatient Indian providers. Note that different rules apply to outpatient Indian providers who enroll in Medicare or Medicaid as FQHCs.
- FQHC Look-Alike (FQHC LA): Look-Alikes are health centers that have been certified by the federal government as meeting all the Health Center Program requirements, but do not receive funding under the Health Center Program.
- Community Health Center (CHC): A general term not defined in the Section 330 statute that is used to describe health centers, due to their community-based nature. It encompasses several types of health centers.
- Health Center: is a non-specific term that does not specifically identify whether a health facility is a health center program grantee, FQHC, or an FQHC-LA.
For the remainder of this guide, the term “health centers” will be used to refer to grantees and FQHC Look-Alikes.
If you are interested in becoming an FQHC, see So You Want to Start a Health Center...? A Practical Guide for Starting a Federally Qualified Health Center.
Frequently Asked Questions
- What are the benefits of being a Federally Qualified Health Center (FQHC) or an FQHC Look-Alike?
- What is the Section 330 Public Health Service Act Health Center Program?
- How do I apply for the Section 330 PHS Act Health Center Program grant?
- Are Section 330 grants awarded on a competitive basis?
- What specific special populations can organizations apply for Health Center Program funding to serve?
- Can a for-profit clinic be a health center?
- Is a board of directors required?
- Are there location requirements for FQHCs?
- Are there special staffing requirements for health centers?
- What types of services do health centers provide?
- Are there minimum hours that a health center must be open?
- Is a sliding fee scale required?
- Must health centers accept all patients, regardless of their ability to pay?
- Are there special programs to assist health centers in attracting and retaining healthcare providers to their organization?
- What are the Medicare Administrative Contractors (MACs) and what is their role in administering Medicare Part A and Part B?
- How do I get certified as an FQHC or Look-Alike?
- What strategies have rural health centers used to meet the requirements related to the provision of mental health services and dental services?
- Can another healthcare organization such as a Critical Access Hospital, own an FQHC?
- Are there funding opportunities available for the expansion, renovation, purchase of major equipment, or new construction of FQHCs?
- Who can I contact for additional information about Federally Qualified Health Centers?
What are the benefits of being a Federally Qualified Health Center (FQHC) or an FQHC Look-Alike?
The main purpose of the FQHC Program, under both Medicare and Medicaid, is to enhance the provision of primary care services in underserved urban and rural communities. FQHCs must fall under one of the following categories before they are eligible for benefits:
- Meets requirements of the Health Center Program and receives a grant under Section 330 of the Public Health Service Act
- Is a health center “Look-Alike”, meaning that they meet the requirements of the Health Center Program but do not receive Section 330 grant funding
- Is an outpatient health program or facility operated by a tribe or tribal organization
There are many benefits of being an FQHC including:
- A per-visit bundled payment, based on historical costs, for services provided under Medicare
- Reimbursement under the Prospective Payment System (PPS) or other State-approved Alternative Payment Methodology (APM) for services provided under Medicaid
- Eligibility to purchase prescription and non-prescription medications for outpatients at reduced cost through the 340B Drug Pricing Program
- Access to the Vaccine for Children Program
- Automatic designation as a Health Professional Shortage Area (HPSA). The HPSA designation provides eligibility to apply to receive National Health Service Corps (NHSC) personnel and eligibility to be a site where a J-1 Visa physician can serve.
- Eligibility for various other federal grants and programs
Additional benefits are available for Health Center Program Grantees, including:
- Grant funding - for new grantees, funding up to $650,000 can be requested
- Medical malpractice coverage is provided for the health center organization, their employees, and eligible contractors under the Federal Tort Claims Act (FCTA), see HRSA’s Health Center Program Federal Tort Claims Act (FTCA) for additional information. Note that FTCA coverage is available only to Health Center Grantees, not FQHC Look-Alikes.
What is the Section 330 Public Health Service Act Health Center Program?
Section 330 of the Public Health Service (PHS) Act defines the Federal Health Center Program as the funding opportunity for organizations to provide care to underserved populations. Some of the benefits to health centers participating in this program include funding to help with the costs of uncompensated care and federal loan guarantees for facility improvement projects. These funds are dispersed from HRSA through the Bureau of Primary Health Care.
Types of organizations that may apply are private non-profit outpatient clinics that meet the Section 330 Program Requirements. Once they receive the grants, they become community, migrant, homeless, or public housing health centers.
View full-text of Title 42 of the U.S. Code, Chapter 6A, Public Health Service Act, and section 254b (the equivalent of Section 330).
How do I apply for the Section 330 PHS Act Health Center Program grant?
The first step is to make sure your location or population served is eligible, that you have community support, and that you are able to meet the full list of Section 330 program requirements. Also, you can only apply at a time that HRSA is accepting applications for New Access Points.
To determine if your target population is a Medically Underserved Area or Population see: MUA/MUP database.
To determine community support, you may want to hold a public meeting. This will help you identify the people and groups who will be willing to work with you on this project.
New Access Point funding opportunities for Section 330 grants are posted on the funding and opportunities section of this guide and on Grants.gov, when available. The application guidance will include a description of how applicants can submit a Letter of Interest (LOI) to the Bureau of Primary Health Care.
Are Section 330 grants awarded on a competitive basis?
Yes. Occasionally HRSA announces that they have funding available to start New Access Points (NAPs), which are new sites that are either the “child” site of an existing Section 330 health center, or a new health center organization. In addition, once every 3 years (and more often if necessary), existing grant awards are re-competed. This means that any organization can apply for the grant funding, and the decision about who receives the grant is made by HRSA on a competitive basis. If the existing grantee would like to continue receiving the grant, they must re-apply for it, and potentially another organization could win the competition and take over the grant.
What specific special populations can organizations apply for Health Center Program funding to serve?
Healthcare organizations can apply for grants under Section 330 of the Public Health Service Act that serve special populations. Migrant Health Centers, Health Care for the Homeless Programs, and Public Housing Primary Care Programs are community-based and patient-directed health centers providing primary care to low-income, underserved populations with limited access to healthcare.
Migrant Health Centers provide comprehensive and culturally competent primary health services to migratory and seasonal farmworkers and their families. Additional focuses of this program are on prevention and occupational health and safety.
Healthcare for the Homeless Program serve patients who live on the street, in shelters or in temporary housing. They provide comprehensive healthcare services that include substance abuse and mental health services.
Public Housing Primary Care Health Centers provide residents of public housing access to comprehensive primary care services. Often these services are provided on the public housing premises or within easy access to residents.
Can a for-profit clinic be a health center?
No. A health center must be a public entity or a private non-profit.
Is a board of directors required?
Yes, health centers receiving Section 330 grants and Look-Alikes must be governed by a board of directors. The board must include a majority (at least 51%) of active, registered patients of the health center who are representative of the populations served by the center. The governing board ensures that the center is community-based and responsive to the community’s healthcare needs. Under certain conditions, the board composition requirements can be waived for migrant, homeless, and public housing health centers. For additional information see Health Center Program Requirements.
Are there location requirements for FQHCs?
It depends. Each FQHC that receives PHS 330 grant funding must meet the requirements of that grant. Community health centers must serve a Medically Underserved Area (MUA) or Medically Underserved Population (MUP). Migrant Health Centers, Health Care for the Homeless, and Public Housing Primary Care Programs do not need to meet the MUA/MUP restriction. FQHCs may be located in rural or urban areas.
Are there special staffing requirements for health centers?
No, there are no specific requirements for staffing mix at health centers. Health centers must maintain a core staff that is able to carry out the required and additional health services of the health center. This will vary from health center to health center based on the needs of the community. Additional information about staffing and other requirements is available in HRSA's Health Center Program Requirements.
What types of services do health centers provide?
Health centers must provide primary care services for all age groups. Health centers must provide preventive health services on site, or by arrangement with another provider. Other services that must be provided directly by a health center or by arrangement with another provider include:
- Dental services
- Mental health and substance abuse services
- Transportation services necessary for adequate patient care
- Hospital and specialty care
For more information, please see HRSA's Health Center Program Requirements.
Are there minimum hours that a health center must be open?
While there are no specific requirements on hours, FQHCs, Look-Alikes, and health center program grantees are required, on an organizational level, to provide services at times and locations that assure accessibility and meet the needs of the population to be served, and to record their hours of operation in the current scope of project (as described on Form 5B).
However, health centers may be subject to minimum hour requirements to receive certain FQHC or grantee benefits. For example:
- Minimum hours are required in order for providers to receive FTCA coverage, which is discussed in HRSA’s Federal Tort Claims Act Health Center Policy Manual.
- Minimum patient-care hours are required for National Health Service Corp (NHSC) providers.
Additionally, individual state Medicaid agencies, CMS, and private third party insurers may have their own policies regarding operational hours and schedules. Each health center is responsible for ensuring that they comply with the requirements of the benefit/third party payer programs they participate in.
Is a sliding fee scale required?
By law, health center grantees and Look-Alikes may charge no more than a nominal fee to individuals whose incomes are below the Federal Poverty Level (FPL). Individuals with incomes between 101% and 200% FPL must be charged using a sliding fee scale with discounts based on patient family size and income. For more information, see HRSA's Health Center Program Requirements.
Must health centers accept all patients, regardless of their ability to pay?
Yes. This is a key requirement of the Health Center program. No patient may be turned away.
Are there special programs to assist health centers in attracting and retaining healthcare providers to their organization?
Health centers (i.e. FQHCs, Look-Alikes, health center grantees) are eligible for a variety of federally funded programs that can be used to attract and retain healthcare providers within their organization including:
- National Health Service Corps Recruitment and Retention Assistance – program provides support for eligible healthcare facilities in recruiting and retaining qualified primary care clinicians.
- J-1 Visa Waivers – allow international medical graduates pursuing residency and fellowship training to remain in the U.S. once their training is complete and practice in a federally designated Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA).
- Teaching Health Center Graduate Medical Education – program funds medical education expenses for training residents in community-based primary care residency programs that include FQHCs and FQHC Look-Alikes.
What are the Medicare Administrative Contractors (MACs) and what is their role in administering Medicare Part A and Part B?
Medicare Administrative Contractors (MACs) are selected by the Centers for Medicare & Medicaid Services (CMS) to administer and process Medicare Part A and Medicare Part B claims. MACs serve as the primary contact between the Medicare Fee-For-Service program and healthcare providers enrolled in the Medicare program. They enroll healthcare providers in the Medicare program and educate providers on Medicare billing requirements. For more information, please see the CMS overview of Medicare Administrative Contractors. To access a CMS Medicare Administrative Contractor within your state, see the CMS Review Contractor Directory - Interactive Map.
How do I get certified as an FQHC or Look-Alike?
Community Health Centers, Migrant Health Centers, Health Care for the Homeless Programs, and Public Housing Primary Care Programs that receive grant funding under Section 330 of the PHS Act are automatically certified as FQHCs.
Existing clinics that meet FQHC requirements, but do not receive Section 330 funding, can request certification as FQHC Look-Alikes. For more information on the Health Center Look-Alike program, requirements, and application procedures see HRSA's Health Center Program Look-Alikes. Detailed application instructions and links to technical assistance resources can be found on HRSA’s Look-Alike Initial Designation Technical Assistance.
What strategies have rural health centers used to meet the requirements related to the provision of mental health services and dental services?
Many strategies have been developed to meet the requirements related to the provision of mental health services and dental health services. The most common strategies include:
Using the National Health Service Corps to recruit dental and mental healthcare
FQHCs and Look-Alikes are eligible to participate in the National Health Service Corps (NHSC) programs. The NHSC loan repayment program is not limited to primary care providers; they also accept and recruit licensed dental and mental healthcare providers to NHSC approved sites, which include FQHCs. The NHSC scholarship program will pay for a variety of school expenses to students in fully accredited training programs for physicians, dentists, nurse practitioners, certified nurse-midwives and physician assistants.
Contractual Agreements with Dentists
FQHCs and FQHC Look-Alikes are eligible to contract with private dentists for dental services provided within their own dental facilities. Increasing Access to Dental Care Through Public Private Partnerships: Contracting Between Private Dentists and Federally Qualified Health Centers provides detailed information regarding the implementation of a contract with dentists to provide oral health services for underserved populations. This manual includes statutory information on contracting, how grant money from the FQHC program can be used, setting rates for contracted services, and the scope of services that can be contracted.
Implementation of Telemental Health Services
Telemental health, or telebehavioral health, may be implemented in an FQHC to expand their behavioral health services. Increasing Access to Behavioral Health Care Through Technology discusses how to plan, implement, and further develop a telebehavioral health program.
Integration and Co-Location of Mental Health Services
Most FQHCs integrate mental health services within their facility (co-location) and use staff employed by the center to provide onsite mental health services. However FQHCs may use outsourced staff from another facility, or a combination of staff who are outsourced, and/or employed by the FQHC. Most FQHC sites provide mental health services on site, integrated with primary care services. NACHC 2010 Assessment of Behavioral Health Services in Federally Qualified Health Centers looks more closely at the integration of mental health and substance abuse services in FQHCs.
Can another healthcare organization such as a Critical Access Hospital, own an FQHC?
In general, no. However a, city or county public hospital or a 501(c)(3) Critical Access Hospital can own an FQHC if the governing body or board of directors is developed to meet the federal requirements of an FQHC.
Are there funding opportunities available for the expansion, renovation, purchase of major equipment, or new construction of FQHCs?
The Health Resources and Services Administration has often offered grants to support expansion, renovation, purchase of major equipment, or new construction. These grants are posted on HRSA’s Health Center Capital Development Programs website. Other funders may support capital projects and can be found listed on the funding and opportunities section of this guide and the Capital Funding Guide.
Who can I contact for additional information about Federally Qualified Health Centers?
For additional information about Federally Qualified Health Centers and related programs contact one or more of the following:
- For grant questions:
Division of Policy and Development
Bureau of Primary Health Care
Health Resources and Services Administration
- For technical, policy, and operational assistance for new and established health centers including CMS
CMS Regional Office Rural Health Coordinators
- For technical, policy, and advocacy issues:
National Association of Community Health Centers
- For assistance in the establishment of geographic eligibility and the development of an FQHC:
State and Regional Primary Care Associations