If you are looking for a Federally Qualified Health Center in a rural area, you can search by address,
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
Health Center Program award recipients and look-alikes, and certain outpatient clinics associated with tribal
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). How to Become a
Health Center explains that health centers:
Provide a set of comprehensive, high-quality primary care and preventive services regardless of patients'
ability to pay.
Employ interdisciplinary teams and patient-centric approaches.
Deliver care coordination and other enabling services that facilitate access to care.
Collaborate with other providers and programs to improve access to care and community resources.
Are community-based and patient-directed.
HRSA's Bureau of Primary Health Care (BPHC) Health Center Program Compliance Manual provides additional
information on Health Center Program requirements.
There are several distinctions that should be understood related to health centers:
- Health Center Program
Health Center Program Award Recipient – A health center that receives grant
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 for the provision of comprehensive primary care services to underserved communities (or
service areas) and 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-Alike – A look-alike is a health center that has
been designated by HRSA as meeting all the Health Center Program requirements but does not typically
receive award funding under the Health Center Program.
- Federally Qualified Health Center (FQHC)
An FQHC is an outpatient clinic that qualifies for
specific reimbursement under Medicare and Medicaid. FQHCs include Health Center Program award recipients 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 award recipient, 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
award recipients, look-alikes, and FQHCs.
If you are interested in becoming a health center, see How to Become a Health
Center and So You Want
to Start a Health Center?. The Health Center Resource
Clearinghouse also hosts free technical assistance resources and information to support community
health center operations, including websites, publications, databases, webinar recordings, and other materials.
Frequently Asked Questions
What are the benefits of FQHC status?
Once certified by the Centers for Medicare & 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 that is adjusted for the location where services are furnished. CMS provides a
brief overview of the
Medicaid reimbursement under the Prospective Payment System (PPS) or other state-approved Alternative
Payment Methodology (APM). A 2017 Medicaid and CHIP Payment and Access
Commission (MACPAC) issue brief,
Payment Policy for Federally Qualified Health Centers, provides an overview of Medicaid
reimbursement for FQHCs.
What are the benefits of being a Health Center Program award recipient or look-alike?
Health Center Program award recipients and look-alikes may apply for or receive the following benefits:
Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) reimbursement for services
provided to Medicare and Medicaid beneficiaries.
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
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.
HRSA-supported training and technical assistance.
Additional benefits are available for Health Center Program award recipients, including:
Federal grant 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, award
recipients 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 award recipients, not Health Center Program look-alikes.
Loan guarantees for capital improvements.
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
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
New Access Point (NAP) funding opportunities provide operational support
for new healthcare delivery sites under the Health Center Program to expand access to affordable,
and cost-effective primary healthcare services for underserved communities. 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 support continued access to
culturally competent, high-quality primary health care services for communities and populations 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.
Public and private nonprofit organizations that meet the Health Center
Program Requirements may apply for these opportunities. 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, people experiencing homelessness, 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
For more information on the health center look-alike program, requirements, and application procedures, see
HRSA's Health Center Program Look-Alikes.
HRSA Look-Alike Initial Designation Technical Assistance provides detailed application
instructions and links to technical assistance resources.
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
first become a Health Center Program award recipient or Health Center Program look-alike in order to become
an FQHC. After receiving Health Center Program award recipient or look-alike designation, health centers may
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 Medicare
Program Integrity Manual Chapter 10 under 10.2.1.D – Federally Qualified Health Centers.
Where can I find statistics on health centers?
Each year, HRSA-funded health centers are required to report a core set of measures including patient
characteristics, services provided and patient utilization, clinical processes and health outcomes, staffing,
and finances as part of the Uniform Data System (UDS), a standardized reporting system. Publicly available UDS
data on data.hrsa.gov includes:
Program Award Recipient Data and Health Center Look-Alike
Data – In addition to national summaries, users can drill down to view UDS award recipient and
look-alike data by state/territory and by individual health centers.
Patient Characteristics Snapshot
Provides a national summary of health center patient poverty level, insurance status, and race and
Special Populations Funded
Programs – Displays data on health centers that receive grant funding through the Health Care
Homeless, Migrant Health Centers, and Public Housing Primary Care Programs to serve special populations.
Tool – Allows users to view how one state/territory compares to the national average
or to another state/territory on key UDS data points: total number of patients served by service category,
target populations, and other patient characteristics.
Additional UDS data resources include:
UDS Trends Webinar Presentation and Recording
Highlights 2020 UDS data trends in health center patient demographics, staffing, and clinical quality
measures, and offers insights on how health centers delivered quality primary care services to their
communities during the COVID-19 pandemic.
Uniform Data System
(UDS) Resources –
Features technical assistance resources for health centers that support complete, accurate, and timely
submission of an annual UDS reports, including the annual UDS manuals and Program
Assistance Letters, webinars, trainings, fact sheets, validations, and crosswalks.
Uniform Data System (UDS) Mapper: A geospatial mapping tool that can
help evaluate the geographic reach, penetration, and growth of the Health Center Program and its
relationship to other federally linked health resources. The tool provides additional details on health
center service areas, data identifying areas of high need and services available related to the opioid
epidemic, and more. The UDS Mapper tool is free but requires registration to use.
The data.hrsa.gov site offers additional resources:
Health Sites provides data on health center
Data Explorer includes additional details on
location, rural status, and award recipient status.
The National Association of Community Health Centers provides these data sources:
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
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
Determine you can meet the compliance requirements within the specified time period for newly funded
organizations. See the
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 service area. See page 11 of So You Want to Start a Health
a Needs Assessment.
Establish and maintain community support by engaging community members, healthcare providers, and other
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
Establish and engage a patient-majority governing board that meets federal requirements as outlined in the
Health Center Program Compliance Manual.
Identify staffing needs and policies for employment practices, including the recruitment and retention of
Develop a business plan identifying the population groups to be served, management and organizational
structure, projected demand for services, and expected expenses and revenue.
Develop a Sliding Fee
Discount Program and other mechanisms to ensure no one is turned away for the inability to pay.
It may be helpful to contact training and technical assistance organizations such as the Health Center
Program’s National Training and Technical Assistance Partners (NTTAP), Health Center Controlled
Networks (HCCN), and/or your regional or state
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.
Specific information regarding Section 330 award application procedures can be accessed from the technical
assistance sites for New
Access Points or Service
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). However, Health Center
Program Look-Alike Initial Designation applications are accepted on a rolling basis.
Are Health Center Program awards granted on a competitive basis?
Yes. Based upon federal appropriations, HRSA announces if funding is available for New Access Points
(NAPs) competition, which support new sites that are either the satellite site of an existing Section 330
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 award recipient would like to continue receiving the award, they must
but it is possible another organization could be granted the Health Center Program award
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
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 experiencing
currently experiencing homelessness, or live in shelters or temporary housing. They provide comprehensive
healthcare services, including
substance abuse and mental health services.
Public Housing Primary Care Health Centers provide residents of public housing and individuals
living in areas immediately accessible to 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), also known as School-Based Service Sites (SBSS), 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. 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
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 health centers often have sites based in schools, SBHCs are more commonly sponsored by a health center.
However, it is important to note that SBHCs are separate from the Health Center Program. SBHCs may also be
sponsored by organizations, such as a local health department or hospital. Twenty Years of School-Based Health
Care Growth and Expansion reported that of the 2,584 SBHCs in the United States in 2016-2017 school
year, 1,181 were sponsored by an FQHC and 823 were located in rural areas. In addition, approximately 20% of
SBHCs used telehealth that 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
Conduct a needs assessment. Who is your target audience and what are their primary unmet
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
Plan funding sources. 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.
See How can healthcare services be provided in rural schools?
for additional information, including how SBHCs collaborate with school nurses.
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 majority (at least 51%)
of the health center board members must be
patients of the health center and demographically representative of the populations served by the health center.
The remaining board members must be representative of the community being served by the health center and must
be selected for their expertise in relevant subject areas. The governing board ensures that the health 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:
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
location requirements outlined in the notice of funding opportunity. Health centers must be located in or serve
a designated Medically
Area (MUA) or serve a designated Medically Underserved Population (MUP). Migrant and Seasonal Agricultural
Worker Health Centers,
Care for the Homeless, and Public Housing Primary Care Programs do not need to meet the MUA/MUP restriction.
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
based on the needs of the community. Additional information about clinical staffing and demonstrating compliance
available in Chapter
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.
Health centers must also provide enabling services, such as case management and transportation services.
Examples of clinical and enabling services that must be provided directly by a health center or by formal
arrangement with another provider include:
- Preventive dental services
- Well child visits
- Pharmaceutical services
- Translation services for limited English-speaking patients
- Health education
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
However, health centers may be subject to minimum hour requirements to receive certain benefits. For example:
Specific funding opportunities may have related eligibility requirements. 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
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
Health centers are eligible for a variety of federal programs that can be used to attract and retain
healthcare providers within their organization, including:
Can FQHCs be reimbursed by Medicare for telehealth services?
Traditionally, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) could only bill
for telehealth services if the clinic was serving as an originating site, which means where a Medicare
beneficiary was located for a telehealth visit with a provider in a different location. FQHC providers could not
serve as distant sites, or the location of the provider furnishing telehealth services to Medicare
In response to the COVID-19 pandemic, however, Congress passed the Coronavirus Aid, Relief, and
Economic Security (CARES) Act, which was signed into law on March 27, 2020. The CARES Act allowed FQHCs and RHCs
to furnish distant site telehealth services to Medicare patients at any location, including their homes, for the
duration of the COVID-19 public health emergency.
According to Rural
Federally Qualified Health Centers Financial and Operational Performance Analysis 2017-2020, rural FQHCs
conducted 5.8 million visits via telehealth in 2020 compared to 500,000 in 2019. This publication also notes
that the median percentage of total patient visits delivered by telehealth services at rural FQHCs in 2020 was
2022 Medicare Physician Fee Schedule Final Rule updated federal regulations to make permanent the
ability of FQHCs and RHCs to be reimbursed by Medicare for mental health visits that use interactive, real-time
audio-visual and audio-only technology. Beginning January 1, 2022, RHCs and FQHCs are paid for these
services at the same rates they are paid for in-person mental health services.
For more information on changes to rural healthcare and telehealth as a result of COVID-19, see RHIhub's Rural Response to Coronavirus Disease 2019 (COVID-19) and Telehealth Use in Rural Healthcare topic guide.
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 award recipients 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
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. The National Network for Oral Health Access provides resources
to help health centers plan and implement contracts for dental services. Case
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 telebehavioral health services
Telebehavioral health, or telemental health, may be implemented in an FQHC to expand their behavioral health
Access to Behavioral Health Care Through Technology discusses how to plan, implement, and further
develop a telebehavioral health program. According to 2019
HRSA Health Center Program Data, 592 health centers, or 42.74% of health centers, utilized
telemedicine technologies. Of those health centers, 446 used telemedicine for mental health services, and
192 used telemedicine for substance use disorder services. In light of the COVID-19 public health emergency,
1,362 health centers, or 99% of all health centers, utilized telemedicine services in
2020, including 1,283 that provided telemental health services and 893 used telemedicine for
substance use disorder 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
(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
employed staff. Most health centers provide these services onsite, integrated with primary care services.
For examples of health centers that integrated behavioral health, see
Studies of 6 Safety Net Organizations that Integrate Oral and Mental/Behavioral Health with Primary
For additional resources, see the Health Center Resource Clearinghouse priority topic, Behavioral Health.
What do we know about the financial and operational performance of health centers?
Qualified Health Centers Financial and Operational Performance Analysis 2016-2019, a 2021 report from
Capital Link, a National
Training and Technical Assistance Partner (NTTAP) organization, examines financial and operational
characteristics of rural Federally Qualified Health Centers (FQHCs), including patient and payer mix, revenue
mix, financial performance, and quality of care, among other topics. This report shows that the operating
margins for both rural and urban FQHCs declined between 2016 and 2019. However, rural FQHCs consistently had
higher margins than urban facilities during this period. In 2019, the margins for rural FQHCs ranged from -1.1%
in the 25th percentile to 8.2% in the 75th percentile. In 2019, the median percentage of operating budgets spent
on personnel-related expenses at rural health centers was 72%, compared to 73.3% in urban facilities. This
analysis also highlights that rural health centers receive a lower median percentage of patient revenue from
Medicaid at 44%, compared to 70% at urban health centers, but receive a higher percentage of patient revenue
from private insurance than urban facilities (22% versus 9%).
Health Centers in a Time of Change: Results from an Annual Survey, a 2019 analysis from the Kaiser
Family Foundation, notes that 51% of health centers reported receiving more federal funding in the previous
year. This report also states that 52% of health centers reported increasing operating costs and workforce
recruitment were among the top three challenges facing health centers, followed by 31% citing inadequate
physical space. Rural health centers were more likely than urban health centers to include workforce recruitment
(60% vs. 45%) and inadequate physical space (36% vs. 27%) in this list.
The COVID-19 pandemic had a negative impact on the financial performance of rural FQHCs. Financial Impact of COVID-19 on Rural
Federally Qualified Health Centers estimates that rural FQHC had $1.4 billion in COVID-19 related
expenses and $1.7 billion in lost revenue between April 2020 and June 2021. The Centers for Disease Control and
Prevention (CDC) developed a list of
resources to help healthcare facilities respond to COVID-19 and maintain healthcare services during the
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
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)
may be able to operate an FQHC if the CAH's governing body or board of directors is developed to meet the Health
Center Program requirements, the organization meets all other eligibility requirements, and the organization
successfully applies for the program. Other healthcare organizations, such as Critical Access Hospitals and
Rural Health Clinics, are not eligible to operate a health center look-alike.
What is the difference between a Federally Qualified Health Center (FQHC) and a Rural Health Clinic (RHC)?
Although FQHCs and RHCs both provide primary care to underserved populations, there are some fundamental
differences. For example, RHCs must meet prescribed staffing requirements, are not required to charge based on a
sliding fee scale unless it is a National Health Service Corps-approved site, and receive an interim
all-inclusive rate (AIR) payment per visit throughout the clinic's fiscal year. For an additional comparison of
FQHCs and RHCs, see Module 1 –
Introduction to the Rural Health Clinic Program from the National Organization of State Offices of Rural
Health's Rural Health Clinic Technical Assistance Educational Series.
Differences between FQHCs and RHCs
|Federally Qualified Health Centers
||Rural Health Clinics
|Nonprofit or public facility
||For-profit, nonprofit, or public facility
|Required to provide care for all age groups
||May be limited to a specific type of primary care practice (e.g., OB-GYN,
|Must be located in or serve an area with a medically underserved population or
experiencing a shortage of healthcare providers
||Must be located in a rural area designated as a Health Professional Shortage Area,
Medically Underserved Area, or Governor-designated and Secretary-certified shortage area.
|FQHCs may operate in both non-urbanized and urbanized areas
||RHCs must be located in non-urbanized areas, as defined by the U.S. Census Bureau.
May retain RHC status if designation of service area changes.
|Required to have a board of directors – at least 51% must be patients of the
||Not required to have a board of directors
|Minimum services required including, but not limited to, maternity and prenatal
care, preventive health and dental services, emergency care, and pharmaceutical services
||No minimum service requirements
|Required to treat all residents in their service area with charges based on a
sliding fee scale, and no patient can be denied service for the inability to pay
||Not required to charge based on a sliding fee scale unless a National Health
Service Corps-approved site
|Must provide after-hours coverage to respond to patient medical emergencies by
telephone, face-to-face, or by arrangement with another healthcare provider
||Not required to provide a minimum of hours or emergency coverage
|Eligible for the Health Center Federal Tort Claims Act (FTCA) Medical Malpractice
Program through the approval of an annual application to HRSA
||Not eligible for FTCA liability protection
|Required to have ongoing quality assurance program
||Required to conduct a biennial program evaluation regarding quality improvement
|Required to submit an annual cost report and, if more than $750,000 in Federal
funds are spent in the fiscal year, audited financial reports
||Required to submit an annual cost report; however, auditing of financial reports
is not required
Are there funding opportunities available for the expansion, renovation, purchase of equipment, or new
construction of health centers?
The Health Resources and Services Administration (HRSA) has offered grants to support expansion, renovation,
of equipment, or new construction. These grants are posted on HRSA's Capital Development Grant
Technical Assistance website. In addition, HRSA administers the Health Center Facility Loan Guarantee Program (LGP),
which facilitates health centers' access to capital funding and reduces financing costs for the construction,
expansion, alteration, renovation, and modernization of health center medical facilities. Capital Link also receives funding from HRSA to provide health centers
with tools, resources, and services related to capital funding and needs. 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.
For additional information about health centers and related programs contact one or more of