Health care can be expensive, especially if you don’t have a lot of provider options around you. If your financial and health care options are strained, there are plenty of solutions out there for you, but the trouble can be finding them. Not only can you rely on Medicare insurance to help with health care costs if you’re eligible for enrollment, but you may also be able to enroll in Medicaid for further assistance. Of course, there are other programs out there designed to help those in need get the health care that’s right for them. Another of these programs allows a type of facility known as a federally qualified health center (FQHC). If you’re struggling financially and there’s an FQHC near you, this may be a solution to your health care concerns.
Much of the information in this article has been sourced directly from the Centers for Medicare & Medicaid Services (CMS) and the Health Resources & Services Administration (HRSA) Health Center Program site, unless linked elsewhere.
What is an FQHC?
An FQHC is a facility that provides a multitude of patient-centered, integrated health care services to underserved areas and needful patients. These services can range from routine health care and preventive care to substance abuse, mental health, and oral health care services. They often work hand in hand with Medicare insurance and Medicaid and provide health care services in an affordable manner based on a sliding scale. To become certified as an FQHC, a health care facility must meet strict qualifications.
FQHC is a classification of many different types of facilities that allow a focus on affordability and care for the patients.
There also isn’t a single type of FQHC. Instead, it’s a classification of many different types of facilities that allow a focus on affordability and care for the patients. These can include community or migrant health centers, homeless health centers, public housing care centers, or outpatient health programs for tribe or tribal organizations. This allows FQHCs to operate in a geographically or culturally aware and patient-oriented manner.
How are FQHCs Certified?
There are two paths that a health care facility can take to register as an FQHC. The options entail applying through the HRSA’s website as a funded health care center or as a health care center program look-alike. To qualify, a health center must undergo strict compliance and regulatory checks to ensure they fit specific criteria. Generally, an FQHC must be a community-based entity that provides comprehensive and high-quality primary care and preventive services regardless of patients’ ability to pay. They must employ inter-professional teams with coordinated care and collaborate with other programs or providers to improve access to care and community resources.
If a facility or care provider fits that general description, there will be a number of specific criteria they’ll need to fill to qualify. According to CMS, in order to qualify, a provider must meet one of the following requirements:
- Have received a grant under Section 330 of the Public Health Service (PHS) Act or funding via the same grant that’s been contracted to the recipient
- Have not received a grand under Section 330 of PHS Act but the U.S. Department of Health and Human Services (HHS) Secretary allows such a grant based on HRSA recommendation, which qualifies the entity as a FQHC look-alike
- Have been treated as a comprehensive federally funded health center since January 1, 1990, by the HHS Secretary (for Medicare Part B purposes)
- Are operating an outpatient health program or tribe organization facility under the Indian Self-Determination Act or as an urban Indian organization that receives funds under Title V of the Indian Health Care Improvement Act
In addition to meeting one of those criteria, they’ll also need to fulfill all four of these requirements:
- Provide comprehensive services including ongoing quality assurance programs and annual reviews
- Meet all health and safety standards
- Are not approved as a Rural Health Clinic
- Meet all Section 330 PHS Act requirements, including:
- Serve either a designated Medically Underserved Area (MUA) or Medically Underserved Population (MUP)
- Offer people with incomes below 200 percent of the federal poverty guidelines a sliding fee payment scale
- Governed by a patient-majority board of directors
What Should You Know About FQHCs?
If you’re reading this, you’re more likely to be a prospective patient or Medicare insurance beneficiary than someone looking to start an FQHC. It’s nice to know how health care providers can qualify as health centers, but you’re likely to be more interested in how this can affect you. Primarily, the way patients benefit from FQHCs is through receiving affordable health care in areas or situations that otherwise may not offer it. Some health centers focus on geographic areas that have few affordable providers, while others provide services for populations that may struggle with health care access, like homeless populations.
Whatever the focus, they must offer their services on a scale that accounts for income. While the sliding scale may differ between health centers, they all seek to work with you so that you can receive health care that doesn’t cripple you financially.
To qualify for care, the visit must be medically necessary and face to face with a FQHC qualified for medical, mental health, or certain preventive care.
Another benefit of FQHCs are their services aren’t only given at the health centers. They may also take place at the patient’s home, which can include an assisted living facility, a skilled nursing facility that’s covered by Medicare Part A, and even at the scene of an incident or accident.
Finally, there are some requirements that are placed on visits themselves. To qualify for care, the visit must be medically necessary and face to face with a FQHC qualified for medical, mental health, or certain preventive care. In certain, limited circumstances, services can also include a registered nurse or licensed practical nurse for homebound patient visits. In other specific circumstances, qualified practitioners can offer outpatient diabetes self-management training and medical nutritional therapy services when the FQHC meets the requirements to give those services.
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Federally qualified health centers can provide essential health care services to some of the most needful populations and areas, bringing care to situations where it might not otherwise be possible. They do this regardless of someone’s ability to pay, a remarkable and noble act. If you’re in need of an FQHC, you can use the HRSA’s health center search to see what’s available in your area.