Federally Qualified Health Centers (FQHCs) and the Health Center Program
See the Rural Healthcare Surge Readiness for up-to-date and critical resources for rural healthcare systems preparing for and responding to a COVID-19 surge, including information for Ambulatory Care.
If you are looking for a Federally Qualified Health Center in a rural area, you can search by address, state, county, and/or ZIP code at Find a Health Center.
Federally Qualified Health Centers are important safety net providers in rural areas. FQHCs are outpatient clinics that qualify for specific reimbursement systems under Medicare and Medicaid. They include federally-designated Health Center Program awardees, federally-designated Health Center Program look-alikes, and certain outpatient clinics associated with tribal organizations.
Approximately 1 in 5 rural residents are served by the Health Center Program, according to the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC). Health centers provide a comprehensive set of health services including primary care; behavioral health; chronic disease management; preventive care; and other specialty, enabling, and ancillary services, which may include radiology, laboratory, dental, transportation, translation, and social services. To be a qualified entity in the federal Health Center Program, an organization must:
- Offer services to all, 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 its governing board of directors composed of patients
- Serve a Medically Underserved Area or Population
- Provide comprehensive primary care services
- Have an ongoing quality assurance program
HRSA's Bureau of Primary Health Care (BPHC) Health Center Program Compliance Manual provides additional information on health center requirements.
There are several distinctions that should be understood related to health centers:
- Health Center Program
- Health Center Program Awardee – Health centers that receive award funding from the HRSA Bureau of Primary Health Care under the Health Center Program, as authorized by Section 330 of the Public Health Service (PHS) Act. Most awards provide support to contribute to serving an entire underserved community (or service area), while others fund specific underserved populations as mandated in the Section 330 authorization, such as migratory and seasonal agricultural workers, persons experiencing or at risk for homelessness, and residents of public housing.
- Health Center Program Look-Alikes – Look-alikes are health centers that have been designated by HRSA as meeting all the Health Center Program requirements, but do not receive award funding under the Health Center Program.
- Federally Qualified Health Center (FQHC)
FQHCs are outpatient clinics that qualify for specific reimbursement under Medicare and Medicaid. FQHCs include Health Center Program awardees and look-alikes as well as certain outpatient clinics associated with tribal organizations. Note that different rules may apply to outpatient clinics associated with tribal organizations who enroll in Medicare or Medicaid as FQHCs.
- Health Center
A non-specific term that does not identify whether a health facility is a Health Center Program awardee, a health center look-alike, or an FQHC.
For the remainder of this guide, the term
health centers will be used to refer to Health Center Program
awardees, look-alikes, and FQHCs.
Frequently Asked Questions
- What are the benefits of FQHC status?
- What are the benefits for Health Center Program awardees and look-alikes?
- What is the Health Center Program?
- How does a health center become certified as an FQHC?
- Where can I find statistics on health centers?
- How do I apply for a Health Center Program grant?
- Are Health Center Program awards granted on a competitive basis?
- Which special populations can be served by healthcare organizations applying for funding through Section 330 of the Public Health Service Act?
- What are school-based health centers and how would I set one up?
- Can a for-profit clinic be a health center?
- Is a board of directors required?
- Are there location requirements for health centers?
- Are there specific 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 strategies have rural health centers used to provide behavioral health and dental health services to meet the needs of their patient population?
- What are the Medicare Administrative Contractors (MACs), and what is their role in administering Medicare Part A and Part B for health centers?
- Can another healthcare organization, such as a Critical Access Hospital, operate an FQHC?
- Are there funding opportunities available for the expansion, renovation, purchase of major equipment, or new construction of health centers?
- Who can I contact for additional information about health centers?
What are the benefits of FQHC status?
Once certified by the Centers for Medicare and Medicaid (CMS) as an FQHC, health centers are eligible for several benefits including:
- Medicare reimbursement under a Prospective Payment System (PPS), in which Medicare payment is made based on a national rate which is adjusted based on the location of where the services are furnished. CMS provides a brief overview of the FQHC PPS.
- Medicaid reimbursement under the Prospective Payment System (PPS) or other state-approved Alternative Payment Methodology (APM) for services provided under Medicaid. A 2017 Medicaid and CHIP Payment and Access Commission (MACPAC) issue brief, Medicaid Payment Policy for Federally Qualified Health Centers, provides an overview of Medicaid reimbursement for FQHCs.
What are the benefits for Health Center Program awardees and look-alikes?
Health Center Program awardee and look-alike designation from the Health Resources and Services Administration offers health centers:
- Eligibility to purchase prescription and non-prescription medications for outpatients at reduced cost through the 340B Drug Pricing Program.
- Access to the Vaccines for Children Program.
- Automatic designation as a Health Professional Shortage Area (HPSA), which 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. Health centers must still review and sign the NHSC site agreement. Learn more about requirements for health centers to become approved NHSC sites.
Additional benefits are available for Health Center Program awardees, including:
- Federal award funding under Section 330 of the Public Health Service (PHS) Act
- Medical malpractice coverage may be granted for the health center organization, their employees, and eligible contractors under the Federal Tort Claims Act (FTCA). To receive coverage, awardees must submit an application to the HRSA Bureau of Primary Health Care and meet the requirements to attain deemed status. See HRSA's Health Center Program Federal Tort Claims Act (FTCA) for additional information. Note that FTCA coverage is available only to Health Center Program awardees, not Health Center Program look-alikes.
What is the Health Center Program?
Section 330 of the Public Health Service (PHS) Act defines the Health Center Program as a funding opportunity for organizations to provide healthcare services to underserved populations. Benefits to health centers participating in this program include funding to help with the costs of uncompensated care as well as malpractice coverage under the Federal Tort Claims Act.
HRSA’s Bureau of Primary Health Care offers funding opportunities for new and continued Health Center Program funding:
- New Access Point (NAP) funding opportunities are intended to provide operational support for new service delivery sites under the Health Center Program to improve the health of the nation's underserved communities and vulnerable populations by expanding access to affordable, accessible, quality, and cost-effective primary healthcare services. The NAP notice of funding opportunity (NOFO) is posted on the Funding and Opportunities section of this guide and on Grants.gov, when accepting applications. Health Center Program New Access Points Technical Assistance provides specific information about NAP funding.
- Service Area Competition (SAC) funding opportunities are for maintaining accessible and affordable quality healthcare services in areas of need that are currently served by the Health Center Program. Healthcare organizations meeting the Section 330 program requirements are eligible for SAC funding. The SAC program is also posted on the Funding and Opportunities section of this guide and on Grants.gov. Service Area Competition Technical Assistance provides specific information about the program, including the service area announcement table, application resources, and frequently asked questions.
Types of organizations that may apply are public and private nonprofit organizations that meet the Health Center Program Requirements. Once they receive the awards, they become responsible for serving the general community, and/or statutorily mandated special medically underserved populations of migratory and seasonal agricultural workers, homeless individuals, or residents of public housing.
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).
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.
How does a health center become certified as an FQHC?
With the exception of tribal organizations, which may apply to CMS directly to become an FQHC, organizations must first become a Health Center Program awardee or Health Center Program look-alike in order to become certified as an FQHC. After receiving Health Center Program awardee or look-alike designation, health centers may apply to CMS for Medicare FQHC certification, and to their state Medicaid office for Medicaid FQHC certification. Each health center site must separately enroll to receive FQHC certification and Medicare FQHC reimbursement. Prospective FQHC enrollees can review Information on Medicare Participation, Federally Qualified Health Center for details.
More information on certification can be found in the State Operations Manual Chapter 2, section 2826. Additional information on Medicare enrollment for FQHCs can be found in the Medicare Program Integrity Manual Chapter 15 under 18.104.22.168 – Federally Qualified Health Centers.
Where can I find statistics on health centers?
HRSA's Health Center Data & Reporting provides a wide range of options from the Uniform Data System (UDS), which health centers are required to report data to annually:
- National Health Center Data offers national-level data on health center awardee quality measures, health outcomes, patient characteristics, staffing, and more.
- Health Center Program Awardee Data and Health Center Look-Alike Data allow you to drill down to a specific location and see data on services provided, medical conditions, patient characteristics, and costs.
- Health Center Data Comparisons lets you compare either state data to national data or states to one another for patients served, services provided, and patient characteristics.
- Uniform Data System (UDS) Mapper is free, but requires registration to use. It provides additional details on health center service areas, high need and services available related to the opioid epidemic, and more.
The HRSA Data Warehouse offers additional resources:
- Health Sites provides data on health center location.
- Data Explorer includes additional details on operating hours, rural status, and awardee status.
The National Association of Community Health Centers provides these data sources:
- Community Health Center State Level Data and Maps offers state-level data on health center patients, staff, patient visits, and the number of awardees and delivery sites.
- Community Health Center Chartbook, 2020 includes statistics on telehealth services, financial health, workforce status, and many of the data points mentioned above in chart format.
You can also look at the resources we have
listed on Federally Qualified Health Centers (FQHCs) and limit by the topic
Statistics and Data and other
topics of interest for data from other organizations.
How do I apply for a Health Center Program grant?
Applying for health center funding requires significant planning and grant writing resources as the application process can be complex. For those working through the process, it may be helpful to separate the steps of development into manageable tasks. The key aspects of developing a grant proposal for a Section 330 PHS Act Health Center Program can be found in So You Want to Start a Health Center? and include the following:
- Determine you can meet the compliance requirements within the specified time period for newly funded organizations. See the Health Center Program Compliance Manual.
- Confirm your location or the population to be served is an eligible Medically Underserved Area (MUA) or Medically Underserved Population (MUP). See the MUA Find tool.
- Assess the need for health services in the catchment area. See page 11 of So You Want to Start a Health Center?, Developing a Needs Assessment.
- Establish and maintain community support by engaging citizens, healthcare providers and other stakeholders in the local planning and implementation process.
- Find a suitable location for your health center. See page 15 of So You Want to Start a Health Center?, Physical Space Considerations.
- Select a patient-majority governing board that meets federal requirements.
- Identify staffing needs and policies for employment practices, including the recruitment and retention of provider staff.
- Develop a business plan identifying the population groups to be served, management and organizational structure, projected demand for services, and expected expenses and revenue.
It may be helpful to contact training and technical assistance organizations such as National Cooperative Agreement (NCA) holders, Health Center Controlled Networks (HCCN), and/or your state's Primary Care Association (PCA). These entities are funded by HRSA to provide training and technical assistance to health centers, and they have the resources to assist in the growth of health centers within their state or geographic area.
Keep in mind you can only apply at a time that HRSA is accepting applications for New Access Points or for Service Area Competition (Section 330 federal awards).
Are Health Center Program awards granted on a competitive basis?
Yes. Based upon federal appropriations, HRSA announces if they have funding available for New Access Points (NAPs) competition, which support new sites that are either the satellite site of an existing Section 330 health center, or a new health center organization, including Health Center Program look-alikes. In addition, once every 3 years (and more often if necessary), existing Health Center Program award recipients have their service areas re-competed. If the existing awardee would like to continue receiving the award, they must re-apply for it, but it is possible another organization could be granted the Health Center Program award for that service area as SAC is a competitive award opportunity.
Which special populations can be served by healthcare organizations applying for funding through Section 330 of the Public Health Service Act?
Healthcare organizations can apply for awards under Section 330 of the Public Health Service Act to specifically serve statutorily defined special populations.
Migratory and Seasonal Agricultural Worker Health Centers provide comprehensive and culturally competent primary health services to migratory and seasonal agricultural workers and their families. Additional services of this program include disease prevention and occupational health and safety.
The Healthcare for the Homeless Program serves patients who are at risk for homelessness, are homeless, or live in shelters or 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.
What are school-based health centers and how would I set one up?
School-based health centers (SBHCs) provide primary care and other services in or near schools, reducing scheduling and transportation barriers for students, and are often located in communities with higher rates of free or reduced lunches. SBHCs in rural areas are more likely to serve other populations in addition to students, according to the 2013-14 Digital Census Report from the School-Based Health Alliance. School-Based Health Centers in an Era of Health Care Reform: Building on History found that common services include chronic illness management, immunizations, reproductive health services, oral health, substance abuse and mental health treatment.
SBHCs at minimum have a primary care provider on staff and a majority of them also have a behavioral health professional. They may also have dental providers, health educators, dietitians, outreach coordinators, and vision care providers, according to the 2016-17 National School-Based Health Care Census Report from the School-Based Health Alliance.
While SBHCs are most commonly operated by a health center, they may also be sponsored by another type of organization, such as a local health department or hospital. Twenty Years of School-Based Health Care Growth and Expansion reported that there were 2,584 SBHCs in the United States: 1,181 operated by an FQHC and 823 in rural areas, and about 20% of SBHCs used telehealth as of the 2016-17 school year. The Evidence on School-Based Health Centers: A Review also found that SBHCs may be well-suited to reach American Indian and Alaskan Native communities.
A number of organizations offer planning guides and tools for starting SBHCs. General tips provided include:
- Involve the community in the planning process. This could include establishment of a School Health Advisory Committee, which often includes school leadership, the school nurse, students, parents, and others.
- Conduct a needs assessment. Who is your target audience and what are their primary unmet needs?
- Determine the SBHC's organization. What services will you provide? Where? With what staff? How will the SBHC interact with the school? School-Based Health Centers: A Funder's View of Effective Grant Making recommends at minimum a primary care provider and front-office staff member for staffing, and to provide space for a small waiting room, two exam rooms, a bathroom, and an office, as well as internal and external doors to allow for flexible hours. The school nurse and/or school counselor most often facilitates regular communication between school staff and the SBHC.
- Plan funding sources. The School-Based Health Center Capital Program or foundation grants may provide funding for start-up costs. Medicaid/Children's Health Insurance Program billing is common for ongoing costs; Section 330 health center funding, Title X of the Public Health Service Act, and state funding are additional options. Strategizing how to get parent/guardian consent forms for student enrollment was also identified as an important step.
- SBHC 101: Making an Informed Decision about Starting a School-Based Health Center – webinar recording and slides from the School-Based Health Alliance.
- Going Where The Kids Are: Starting, Growing and Expanding School Based Health Centers – webinar recording from Community Health Center, Inc. about the benefits and challenges of health centers adopting SBHCs, as well as strategies for integrating behavioral and oral health.
- A set of modules from the Colorado Association for School-Based Health Care on starting a SBHC.
- Opening a School-Based Health Center: A How-To Guide for West Virginia and start-up tools – while specific to West Virginia, it provides updates from an earlier New Mexico resource.
- Sustainability Tools from the School-Based Health Alliance.
Can a for-profit clinic be a health center?
No. A health center must be a public entity or a private nonprofit organization.
Is a board of directors required?
Yes, a health center must be governed by a board of directors. The board must include a majority (at least 51%) of 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. Health centers under the management of American Indian tribes, organizations, or tribal groups are exempt from specific board composition requirements. For detailed information about board development and management, see Chapter 20: Board Composition of the Health Center Program Compliance Manual. The Health Center Resource Clearinghouse also offers resources related to health center governance.
Are there location requirements for health centers?
Each health center that receives Health Center Program award funding must meet the service area location requirements outlined in the notice of funding opportunity. Health centers must be located in or serve a designated Medically Underserved Area (MUA) or serve a designated Medically Underserved Population (MUP). Migrant and Seasonal Agricultural Worker Health Centers, Health Care for the Homeless, and Public Housing Primary Care Programs do not need to meet the MUA/MUP restriction. Health centers may be located in rural or urban areas.
Are there specific staffing requirements for health centers?
No, there are no specific requirements for staffing mix at a health center. Health centers must maintain a core staff that is able to carry out the required and additional health services of the health center. This may vary based on the needs of the community. Additional information about clinical staffing and demonstrating compliance is available in Chapter 5: Clinical Staffing of the Health Center Program Compliance Manual.
What types of services do health centers provide?
Health centers must provide comprehensive primary care and preventative health services for all age groups. Examples of types of services that must be provided directly by a health center or by formal arrangement with another provider include:
- Preventive dental services
- Well child visits
- Referrals to specialty care providers
- Pharmaceutical services as appropriate
- Patient case management to establish eligibility for health and related services
- Transportation services necessary for adequate patient care
- Translation services for limited English speaking patients
- Health education of patients and the general population
For more information, please see HRSA's Health Center Program Compliance Manual.
Are there minimum hours that a health center must be open?
While there are no specific requirements on hours, health centers are required, on an organizational level, to provide services at times and locations that assure accessibility and meet the needs of the population 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 benefits. For example:
- Minimum hours are required in order for providers to receive Federal Tort Claims Act (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 it complies with the requirements of the benefit/third-party payer programs it participates in.
Is a sliding fee scale required?
Yes, health centers are required to have a sliding fee discount program. Health centers may offer a full discount or elect to have a nominal charge for individuals and families whose incomes are at or below 100% of the Federal Poverty Guidelines (FPG). For individuals with incomes above 100% and at or below 200% FPG, partial discounts are provided using a sliding fee scale with discounts based solely on the patient’s family size and income. No sliding fee program discounts are provided to individuals and families with annual incomes above 200% of the current FPG. For more information about sliding fee scales and nominal charges, see Chapter 9: Sliding Fee Discount Program of the Health Center Program Compliance Manual.
Must health centers accept all patients, regardless of their ability to pay?
Yes. This is a key requirement of the Health Center Program.
Are there special programs to assist health centers in attracting and retaining healthcare providers to their organization?
Health centers are eligible for a variety of federal programs that can be used to attract and retain healthcare providers within their organization, including:
- National Health Service Corps Recruitment and Retention Assistance – A scholarship and loan repayment program that exchanges financial support for years of service at eligible healthcare facilities recruiting and retaining qualified clinicians.
- J-1 Visa Waiver – Allows international medical graduates who have completed residency and fellowship training to remain in the U.S. 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 health centers.
What strategies have rural health centers used to provide behavioral health and dental health services to meet the needs of their patient population?
Many strategies have been developed related to the provision of behavioral health services and dental health services. The most common strategies include:
Using the National Health Service Corps to recruit and retain dental and behavioral healthcare
Health Center Program awardees 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/behavioral healthcare providers to NHSC approved sites, which include health centers. The NHSC scholarship program will pay for a variety of school expenses for students in fully-accredited training programs for physicians, dentists, nurse practitioners, certified nurse midwives, and physician assistants.
Contractual agreements with local dental service providers
Health centers 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 award money from the Health Center Program can be used, setting rates for contracted services, and the scope of services that can be contracted. Case Studies of 8 Federally Qualified Health Centers: Strategies to Integrate Oral Health with Primary Care includes examples of contracted oral health services integrated with primary care.
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. According to a 2018 NACHC publication, The Health Center Program is Increasing Access to Care through Telehealth, nearly half of rural health centers use telehealth technologies, and 56% of those provide telemental health services.
Expansion of dental services to offsite locations
Mobile units and school-based programs are some examples of how health centers have expanded their dental services. The Oral Health Infrastructure Toolkit provides additional tools and information on how to establish these programs.
Integration and co-location of behavioral health services
Most health centers integrate behavioral health (mental health and substance abuse) services within their facility (co-location) and use staff employed by the center to provide onsite behavioral health services. However, health centers may use outsourced staff from another facility, or a combination of staff who are outsourced and employed staff. Most health centers provide these services onsite, integrated with primary care services. For examples of health centers that integrated behavioral health, see Case Studies of 6 Safety Net Organizations that Integrate Oral and Mental/Behavioral Health with Primary Care Services.
For additional resources, see the Health Center Resource Clearinghouse priority topic, Behavioral Health.
What are the Medicare Administrative Contractors (MACs), and what is their role in administering Medicare Part A and Part B for health centers?
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, including healthcare providers affiliated with FQHCs. MACs also support and work with FQHCs by enrolling providers in the Medicare program, educating providers on Medicare billing requirements, handling provider reimbursement and auditing institutional provider cost reports, managing the initial claims appeals process, and establishing local coverage determinations (LCDs). Organizations can also use the online Provider Enrollment, Chain and Ownership System (PECOS) to enroll as an FQHC in Medicare. 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.
Can another healthcare organization, such as a Critical Access Hospital, operate an FQHC?
In general, no. However, a city- or county-owned public hospital or a 501(c)(3) Critical Access Hospital (CAH) can operate an FQHC if the CAH's governing body or board of directors is developed to meet the Health Center Program Requirements.
Are there funding opportunities available for the expansion, renovation, purchase of major equipment, or new construction of health centers?
The Health Resources and Services Administration has offered grants to support expansion, renovation, purchase of major equipment, or new construction. These grants are posted on HRSA's Capital Development Grant Technical Assistance 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 for Rural Healthcare guide.
Who can I contact for additional information about health centers?
For additional information about health centers and related programs contact one or more of the following:
For award questions:
Bureau of Primary Health Care
Health Resources and Services Administration
Health Center Program Support or call 877.464.4772
7:00 am to 8:00 pm ET, Monday through Friday (except Federal holidays)
For technical, policy, and operational assistance for new and established health centers including CMS
CMS Regional Office Rural Health Coordinators
For training, technical assistance, research papers, policy, and advocacy issues:
National Association of Community Health Centers (NACHC)
For assistance in the establishment of geographic eligibility and the development of a health center:
State and Regional Primary Care Associations
Last Reviewed: 8/23/2019