Key findings
Community health centers are a national network of more than 1,300 primary care providers serving more than 30 million patients in 2022. They are located in medically underserved urban and rural communities and serve all patients regardless of their ability to pay . Health centers have also played a major role in the nation’s response to the coronavirus pandemic, particularly for hard-to-reach populations. This brief analyzes changes in health center patients, services and funding from 2019 (pre-pandemic) to 2022 using the Unified Data System (UDS), to which all health centers are required to report annually. Key findings include the following:
- The patient population in health centers has returned to pre-pandemic levels after a decline in the first year of COVID, and has grown slightly from 29.8 million patients in 2019 to 30.5 million in 2022 (2%). But the number of children served by health centers fell somewhat from 9.2 million to 8.8 million (4%) over the same period, with the largest decline in children aged 0-5. There is evidence indicating that utilization of primary and preventive services among Medicaid children remains below pre-pandemic levels, which may partially explain the decline in pediatric patients at health centers.
- The health centers disproportionately served communities of color and low-income people—63 percent of patients were people of color and more than 90 percent had incomes that were at or below 200 percent of the 2022 federal poverty level.
- More people have been returning to in-person care since the start of the pandemic, with more than 105 million health center patient visits made in person in 2022 compared to 85.7 million in 2020, but telehealth is still used at 17% of all visits in 2022
- From 2019 to 2022, the number of visits for mental health and substance use disorder services increased by 21%, with a significant increase in the number of patients diagnosed with anxiety disorders (26% increase) and attention deficit disorders (21% increase). The number of patients receiving medication-assisted treatment (MAT) for an opioid use disorder increased by 36% from 2019 to 2022.
- From 2019 to 2022, the share of health center patients who were uninsured fell from 23% to 19%, while the share of patients covered by Medicaid increased from 49% to 51%, likely due to the current Medicaid continuous enrollment provision from March 2020 through March 2023.
- Medicaid was the largest source of revenue for health centers, providing 42% of all revenue in 2022, while federal grant funding accounted for 12% of total funding. Health center revenues increased by more than $11 billion since 2019, primarily due to growth in Medicaid funding related to the increase in Medicaid patients and funding related to COVID.
Repeal of Medicaid’s continuous enrollment provision will likely affect patients, services and health center funding starting in 2023 as people who are disenrolled from Medicaid enroll in other coverage or become uninsured. KFF tracking shows that more than 20 million people have been disenrolled from Medicaid since the rollout began. An early study using data from health centers found that 17 percent of patients who were covered by Medicaid before the phase-out began were uninsured when they sought care at a health center in the first six months of the phase-out. Among those with the highest rates of disenrollment from Medicaid are patients with HIV/AIDS, mental illness, or SUD. Although Congress recently reauthorized an increase in federal grant funding for health centers through 2024, the increase may not fully offset the decline in Medicaid revenue during the shutdown. Funding drains related to the pandemic could further strain health center finances.
Patients of the Health Center
The number of patients served by health centers increased in 2022, although the number of child patients has not fully recovered to pre-pandemic levels. After the temporary closure of facilities and social distancing guidelines at the start of the coronavirus pandemic in 2020, the number of patients decreased, but in 2021 the number of patients began to increase again and this trend continued in 2022. The health centers served 30, 5 million patients in 2022, an increase of 2% over 2019 (Figure 1). Although the number of adult patients increased, the number of child patients decreased by 4% and remained below the number of children served in 2019.
Health centers served fewer children under the age of five in 2022 compared to 2019, leading to an overall decline in pediatric patients. From 2019 to 2022, the number of children aged 0-5 attending health centers decreased by 14% from 3.2 million to 2.7 million (Figure 1). The largest decrease in the 0-5 age range was among children under 1 year, which decreased from 688,000 patients in 2019 to 471,000 in 2022 (a 32% decrease). There was a smaller decrease in the number of patients aged 6-11 (3%), while children aged 12 and over saw a 5% increase compared to the number of patients before the pandemic.
Most patients at the health centers were people of color, and the vast majority were low-income. In 2022, people of color represented 63% of health center patients, and Hispanic patients made up the largest proportion of patients at 39% (Figure 3). Health centers also served many patients with limited English proficiency, with approximately one in four patients (26%) best served in a language other than English. Reflecting their role as safety net providers, nine out of ten health center patients had incomes that were at or below 200% of the federal poverty level (FPL), and two-thirds (66%) had incomes at or below 100% FPL in 2022 (Figure 3).
Health center services
Even as patients in health centers returned to in-person care in 2022, reliance on telehealth continued. Health centers provided a total of 126.9 million visits in 2022, including 21 million telehealth visits (Figure 4). Telehealth visits accounted for 17% of total visits, a significantly larger share from 2019’s baseline of less than 1%, but down from a high of 25% at the height of the pandemic in 2020. While in-person visits increased over 2020, they remained below pre-pandemic levels.
Mental health, substance use disorder (SUD) and medical services led to growth in health center visits from 2019 to 2022, while visits for dental and vision services remained below pre-pandemic levels. Overall, visits to health centers were 3% higher in 2022 compared to 2019. Visits for mental health and SUD services increased by 21%, with more modest growth for providers (9%) and medical services (4%) (Figure 5). Services that are largely provided in person, namely eye and dental, declined by 3% and 17% respectively over the same period.
Consistent with the increase in mental health and SUD visits, the number of health center patients diagnosed with certain mental disorders and SUDs increased in 2022. Compared to 2019, there is a noticeable increase in the number of patients suffering from anxiety disorders (26%) and attention deficit and behavioral disorders (21%) in 2022 (Figure 6). In addition, the number of patients receiving medication-assisted treatment (MAT) for opioid use disorder has increased by 36% since 2019.
Health Center Revenue Sources
The share of health center patients who were uninsured continued to decline, while the share of Medicaid enrollees exceeded 50%. From 2019 to 2022, the share of uninsured patients fell four percentage points from 23% to 19%, while the share of Medicaid patients increased from 49% to 51%, further cementing Medicaid as the largest source of patient coverage (Figure 7). Both changes are largely due to the Medicaid continuous enrollment provision, which temporarily halted Medicaid exclusions from March 2020 to March 2023. After March 2023, states resumed exclusions as part of the Medicaid shutdown.
Medicaid continued to be the largest source of health center revenue, although federal grants and COVID-related funding were also significant sources of revenue in 2022. Medicaid accounted for 42% of health center revenue in 2022, while federal Section 330 grant funding, which supports health centers’ role as safety net providers, accounted for 12% of health center revenue nationally (Figure 8). Additionally, pandemic-related funding accounts for 8% of all health center revenue in 2022, even though that funding has expired. Health center revenues have increased by more than $11 billion since 2019, primarily due to growth in Medicaid funding related to the increase in Medicaid patients and funding related to COVID.
