Recent Trends in Community Health Center Patients, Services, and Financing

Key Takeaways

Community health centers are a national network of over 1,300 safety-net 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 also played a major role in the nation’s response to the coronavirus pandemic, particularly for hard-to-reach populations. This brief analyzes the changes in health center patients, services, and financing from 2019 (pre-pandemic) through 2022 using the Uniform Data System (UDS), to which all health centers are required to report annually. Key takeaways include the following:

• The health center patient population has returned to pre-pandemic levels after dipping during the first year of COVID and is up slightly from 29.8 million patients in 2019 to 30.5 million in 2022 (2%). But the number of children served by health centers decreased somewhat from 9.2 million to 8.8 million (4%) during the same period, with the greatest decline among children ages 0-5. There is evidence indicating that utilization of primary and preventive services among children on Medicaid remains below pre-pandemic levels, which may partially explain the drop in pediatric patients at health centers.
• Health centers disproportionately served communities of color and low-income people—63% of patients were people of color and over 90% had income that was at or below 200% of the federal poverty level in 2022.
• More people were returning to in-person care since the start of the pandemic, with over 105 million health center patient visits conducted in-person in 2022 as compared to 85.7 million in 2020, but telehealth was still utilized in 17% of all visits in 2022.
• From 2019 to 2022, the number of visits for mental health and substance use disorder services increased 21%, with large increases in 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 opioid use disorder increased 36% from 2019 to 2022.
• From 2019 to 2022, the share of health center patients who are uninsured dropped from 23% to 19%, while the share of patients covered by Medicaid increased from 49% to 51%, likely due to the Medicaid continuous enrollment provision that was in place from March 2020 through March 2023.
• Medicaid was the largest revenue source for health centers, providing 42% of all revenue in 2022 while federal grant funding comprised 12% of total funding. Health center revenues increased by over $11 billion since 2019, primarily due to growth in Medicaid funding related to the increase in Medicaid patients and COVID-related funding.

The unwinding of the Medicaid continuous enrollment provision will likely impact health center patients, services, and financing starting in 2023 as people who are disenrolled from Medicaid enroll in other coverage or become uninsured. KFF tracking indicates that more than 20 million people have been disenrolled from Medicaid since the start of the unwinding. Early research conducted using health center claims data found that 17% of patients who were covered by Medicaid prior to the start of unwinding were uninsured when they sought care at a health center during the first six months of unwinding. Among those with the highest Medicaid disenrollment rates were patients with HIV/AIDS, mental health conditions, or SUDs. While Congress recently reauthorized increased federal grant funding for health centers through 2024, the increase may not fully offset any drop in Medicaid revenue during the unwinding. The expiration of pandemic-related funding could further stress health center finances.

Health Center Patients

The number of patients served by served by health centers increased in 2022, although the number of child patients has not fully rebounded to pre-pandemic levels. Following temporary site closures and social distancing guidance at the start of the coronavirus pandemic in 2020, the number of patients dipped, but in 2021, the number of patients began increasing again and that trend continued in 2022. Health centers served 30.5 million patients in 2022, an increase of 2% from 2019 (Figure 1). Although the number of adult patients increased, the number of child patients decreased by 4% and remains below the number of children served in 2019.

Health centers served fewer children ages five and under in 2022 compared to 2019, driving the overall drop in pediatric patients. From 2019 to 2022, the number of children 0-5 visiting health centers decreased 14% from 3.2 million to 2.7 million (Figure 1). The largest decline in the 0-5 age range was among children under age 1, which declined from 688,000 patients in 2019 to 471,000 in 2022 (a 32% drop). There was a smaller decrease in the number of patients ages 6-11 (3%), while children ages 12 and over saw a 5% increase over pre-pandemic patient numbers.

Most health center patients 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 comprised the largest share of patients at 39% (Figure 3). Health centers also served many patients with limited English proficiency, with roughly one in four patients (26%) who were best served in a language other than English. Reflecting their role as safety-net providers, nine in 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 health center patients 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 represented 17% of total visits, a substantially larger share than the 2019 baseline of less than 1%, but down from the high of 25% during the height of the pandemic in 2020. While in-person visits increased relative to 2020, they remained below pre-pandemic levels.

Mental health, substance use disorder (SUD), and medical services drove growth in health center visits from 2019 to 2022, while visits for dental and vision services remained below pre-pandemic levels. Overall, health center visits were 3% higher in 2022 compared to 2019. Visits for mental health and SUD services increased by 21%, with more modest growth in enabling services (9%) and medical services (4%) (Figure 5). Services that were largely provided in person, namely vision 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 health and SUD disorders increased in 2022. Compared to 2019, there was a notable increase in the number of patients experiencing anxiety disorders (26%) and attention deficit and behavior disorders (21%) in 2022 (Figure 6). In addition, the number of patients receiving medication-assisted treatment (MAT) for opioid use disorder increased 36% from 2019.

Health Center Revenue Sources

The share of health center patients who were uninsured continued to decline while the share enrolled in Medicaid surpassed 50%. From 2019 to 2022, the share of uninsured patients dropped four percentage points from 23% to 19% while the share of Medicaid patients increased from 49% to 51%, further solidifying Medicaid as the largest source of coverage for patients (Figure 7). Both of these changes are largely attributable to the Medicaid continuous enrollment provision, which temporarily halted Medicaid disenrollments from March 2020 through March 2023. After March 2023, states resumed disenrollments as part of the Medicaid unwinding.

Medicaid continued to be the largest source of health center revenue, though federal grants and COVID-related funding were also significant revenue sources 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, made up 12% of revenues at health centers nationally (Figure 8). Additionally, pandemic-related funding made up 8% of all health centers’ revenue in 2022 although this funding has since expired. Health center revenues increased by over $11 billion since 2019, primarily due to growth in Medicaid funding related to the increase in Medicaid patients and COVID-related funding.