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A new study offers compelling evidence that Community Health Centers (CHCs) are essential to saving lives. Published in the May 2025 issue of the journal Health Services Research, the study finds a link between the closure of CHC sites and measurable increases in mortality. 

As our nation’s largest primary care system serving at least one in 10 Americans overall and one in five rural Americans, this new data underscores that CHCs save lives and CHC closures can lead to the loss of life.  

The study, “Impact of Community Health Center Losses on County-Level Mortality: A Natural Experiment in the United States, 2011–2019,” was co-authored by Sanjay Basu, MD, Bob Phillips, MD, and Hank Hoang. Writing on LinkedIn, the authors described their study design:

“We employed a natural experiment caused by previous funding lapses and their differential impact across geographies to study the impacts of community health centers on mortality, finding that health center losses from a community were related to increased mortality net of other factors.”

The study (link is for subscribers only) included 3,142 U.S. counties, with 177 counties experiencing CHC site losses in 2014, per data from the Health Resources and Services Administration. Their findings included:  

  • CHC site losses were associated with an increase of 3.54 deaths per 100,000 population annually. 
  • Mediation analysis revealed that loss of both the primary care workforce and patient access to care contributed to the findings. 

While CHCs serve 10% of the U.S. population, they represent roughly 1% of total annual healthcare spending in the U.S. By keeping people healthy, the evidence is clear: CHCs don’t just save money – they save lives. 

FOR IMMEDIATE RELEASE

Contact: Amy Simmons Farber, 202-309-0338

Bethesda, MD — House passage of the “One Big, Beautiful Bill” (H.R. 1) reconciliation bill puts millions of Americans at risk of losing health coverage, including millions of Community Health Center (CHC) patients. NACHC is deeply concerned about the immediate impact of this legislation and urges the Senate to take into consideration the important role health centers play in serving their patients. 

“CHCs save lives and money and proudly serve more than 16 million patients insured through Medicaid who include veterans, children, seniors, farmers, ranchers, and families who need affordable healthcare,” said Kyu Rhee, MD, MPP, President and CEO of NACHC. “CHC patients who are insured through Medicaid stay healthier thanks to regular access to high quality, comprehensive primary care. These patients have fewer Emergency Department visits, hospitalizations, and specialty visits than patients at other providers, saving lives and billions of taxpayer dollars every year. We need healthcare reforms that incentivize greater access and investments in affordable, comprehensive, effective primary care.” 

Two million Community Health Center patients could lose health coverage 

Based on the Congressional Budget Office projections, NACHC estimates that the House bill could cause 2 million patients insured through Medicaid to lose health coverage. Patients insured through Medicaid rely on their local health centers to help them manage their diabetes, high blood pressure, substance use, behavioral health, and so many other chronic conditions. 

CHCs already face significant financial challenges and cannot absorb further reductions in Medicaid funding. These proposals come at a time of intense financial pressure that is already straining CHCs. The average financial margin for CHCs approaches a negative 2.2% while 42% of CHCs report having 90 days or less cash on hand.  

As the Senate takes up the budget reconciliation process, CHCs stand ready to work with leaders on policy changes that invest in primary care and Medicaid and deliver cost-savings to taxpayers.  

Photo Credit: Mary’s Center

Community Health Centers (CHCs) are critical in delivering affordable primary care to 32.5 million Americans, 90 percent of whom live in poverty. A large share of the 1 in 5 people who get health insurance through Medicaid and low-income individuals (1 in 3) who might otherwise struggle to access primary care depend on CHCs for life-saving care.  

One in eight Medicaid enrollees at CHCs are children, including the 13-year-old daughter of Rachel Stankowski, PhD, Community Health Strategy Director of the Family Health Center of Marshfield in Central Wisconsin. When Rachel adopted her daughter from foster care, she encountered unexpected challenges accessing dental care. 

“I didn’t realize how difficult it would be until I struggled to get my daughter into dental services,” Rachel explains. “I was even willing to pay out of pocket, but the dental provider I’d seen for more than 10 years refused to treat my daughter simply because she had Medicaid. I was so grateful that Family Health Center was willing to see my daughter, who had cavities that were visible to the naked eye.” 

Medicaid beneficiaries also include veterans, seniors, people fighting cancer, children, and people living with disabilities. If they lose coverage, newly uninsured patients will likely delay or forgo necessary care, leading to more serious health conditions, emergency department visits, and higher long-term healthcare costs.  

Hospitals and other healthcare providers that partner with CHCs may also face further financial strain from Medicaid cuts, particularly in rural areas where CHCs help offset hospital overcrowding and reduce uncompensated care.

Workforce Shortages and Rising Demand for Affordable Care

Though a vital part of the U.S. healthcare system, CHCs continue to struggle with workforce shortages. As of 2023, CHCs employed over 310,000 staff members, including more than 16,000 physicians and 13,000 nurse practitioners. However, the U.S. Department of Health and Human Services, which oversees the federal CHC grant program, estimates a shortfall of 35,000 primary care providers by 2030. This shortage is most acute in rural areas, where lower salaries hinder recruitment and retention.  

CHCs have long relied on loan repayment programs to recruit clinicians but have also developed and expanded successful community-based training programs like the Teaching Health Center Graduate Medical Education, which has helped to reduce primary care shortages since its inception, and the Nurse Practitioner Residency program. Without sustained investment in these and other workforce initiatives, many CHCs will be unable to fill vacancies in key clinical roles, including behavioral health providers, dentists, and pharmacists.  

A 2024 survey by the NACHC found that 55% of CHCs report difficulties in filling open positions and 86% could not offer competitive salaries. These workforce challenges impact service delivery and put additional strain on existing staff, exacerbating burnout and turnover.

The precarious state of multi-year federal CHC funding, combined with looming Medicaid reductions and tightening eligibility requirements, threatens to deepen an already critical workforce crisis.

Impact of Medicaid Cuts on the CHC Workforce

The stability of the CHC workforce is deeply intertwined with Medicaid financing. Medicaid is the single largest source of revenue for CHCs, accounting for 42% of total CHC operating revenue. When Medicaid enrollment drops or rates are cut, CHCs lose the revenue needed to maintain staff and services.   

Since the end of continuous enrollment projections, more than 25 million people lost Medicaid coverage, and 69% of disenrollment were due to paperwork or procedural reasons.  As a result, CHCs lost an average of $600,000 in Medicaid revenue, and one in 10 CHCs reduced staff or scaled back services. 

Federal training initiatives, such as the Teaching Health Center program, also rely on stable Medicaid financing. These programs require not only  adequate per resident amount funding but also financially secure CHCs capable of hosting and training new clinicians.  When Medicaid resources are strained, opportunities to grow the future workforce diminish. They disrupt and weaken the pipeline of future clinicians, further straining the few providers who remain.   

This challenge is compounded by the unstable outlook for federal CHC funding. For decades, this essential support has depended on short-term reauthorizations, undermining long-term workforce planning and contributing to persistent uncertainty. Without reliable funding, CHCs face a double burden of retaining their current workforce while struggling to train the next generation.

Conclusion

The precarious state of multi-year federal CHC funding, combined with looming Medicaid reductions and tightening eligibility requirements, threatens to deepen an already critical workforce crisis. These financial pressures force CHCs into an impossible choice: scaling back vital services precisely when communities need them to thrive.  

Behind these statistics are real people with nowhere else to turn for affordable care. The time to safeguard access to essential community lifelines is not tomorrow — but today.

As Congress debates major changes to Medicaid, millions of Americans are at risk of losing coverage. The bill currently being considered in the House includes changes to Medicaid that NACHC estimates would lead to major losses in health coverage for Community Health Center (CHC) patients. These policies will affect patients’ health and the financial health of CHCs. 

Estimating the Number of CHC Patients Insured Through Medicaid Who Could Lose Coverage 

In its analysis of the House bill, the Congressional Budget Office projects that by 2034, 10.3 million people will lose Medicaid coverage and 7.6 million will become uninsured. Of those figures, NACHC estimates that roughly 2 million CHC patients will lose coverage and CHCs will see 1.7 million more people without insurance.  

For CHC patients, losing Medicaid coverage means losing access to essential healthcare services, like primary and preventive care. It means a lapse in managing chronic diseases, skipping life-saving screenings, and forgoing other primary care services. It also raises patients’ risk of acquiring medical debt. 

Community Health Centers Will See More Uninsured Patients  

For CHCs, this growing coverage gap will mean they see a larger share of patients without insurance, while they are already straining to meet rising demand.  

By law and by mission, CHCs serve all patients who walk through their doors, regardless of income or insurance status. A decade ago, CHCs served 15% of the nation’s uninsured. That number now exceeds 22% (Figure 1). At the same time that CHCs are experiencing increases in uninsured patients, they are operating under stagnant federal funding levels.

Medicaid Cuts Will Harm Community Health Center Operations and Impact 

CHCs rely heavily on two major funding sources: Medicaid, which provides about 42% of CHC revenue, and federal Section 330 grants, which account for approximately 12% of CHC funding.   

Reductions in federal Medicaid spending could lead directly to reduced services, staff layoffs, and, in some cases, clinic closures. Currently, the majority of CHCs face negative financial margins, and one in four CHCs may close or reduce services over the next two years without increased funding.  

CHC federal grant funding remains uncertain beyond September 2025. Without long-term reauthorization, CHCs would face financial instability, forcing them to halt expansion projects, scale back services, freeze hiring, or cut essential patient services. 

CHCs want to partner with lawmakers as they deliberate changes to the healthcare system. CHCs’ unique role and proven track record of delivering high-quality care and meaningful savings is a model for the broader system. Greater investment in primary care leads to better outcomes, higher patient satisfaction, and reduced costs. Policymakers should re-focus the healthcare system by prioritizing greater investment in primary care and considering how policy changes impact CHCs and their patients.  

View NACHC Medicaid resources: Find resources to take action and share with your networks why Medicaid matters to CHC patients, CHCs, and the community.

The newly released reconciliation bill from the U.S. House Committee on Energy and Commerce proposes changes to Medicaid that would result in millions of Americans who rely on Medicaid for health coverage losing access to healthcare, including Community Health Center (CHC) patients.

Nationwide, CHCs care for one in five people in the U.S. who have health insurance through Medicaid. The Trump administration’s goal of Making America Healthy Again presents an opportunity to refocus the healthcare system on primary care to lower rates of chronic disease, increase adoption of healthier lifestyles and reduce long-term federal healthcare spending. Doing so will require strong Community Health Centers, which make up the largest primary care network in the nation.

CHCs proudly serve more than 16 million patients insured through Medicaid who include veterans, children, seniors, farmers, ranchers, and families who need affordable healthcare. Because half of CHC patients get health coverage through Medicaid, they stay healthier with regular access to coordinated primary care. These patients have fewer Emergency Department visits, hospitalizations, and outpatient procedures than patients at other providers, saving taxpayer billions of dollars every year.

Medicaid Restrictions May Harm Healthcare Access for Patients and Raise Healthcare Costs

Preliminary estimates by the Congressional Budget Office found that, if enacted, the bill’s Medicaid provisions would cause millions to lose health insurance.

Medicaid is the lifeblood of CHCs, accounting for over 40% of their revenue on average. When CHC patients lose Medicaid coverage, they can still access care at CHCs, which are required by law to serve all patients, regardless of their insurance status or ability to pay. With millions losing Medicaid coverage, CHCs will lose revenue and take on additional uncompensated care costs. Cutting Medicaid will affect patients’ health and the financial health of CHCs.

CHCs are already facing significant challenges in meeting the costs of patient care and cannot absorb further reductions to Medicaid funding. Medicaid cuts could trigger a cascade of site closures and service reductions that ultimately cost taxpayers more through increased emergency care and hospitalizations.

Even a small shift in patients from Medicaid to uninsured status could force clinics to reduce services or close locations, jeopardizing access to cost-effective primary care and medical services in communities.

Rural communities would lose critical access points for primary care, dental services, and behavioral health. When CHCs close, communities lose not just healthcare but also jobs and economic stability. Terminating Medicaid coverage for gig workers, freelancers, caregivers, and those who have been laid off will not only compromise their health but also make it harder for them to work.

The partnership between CHCs and Medicaid is fundamental to improving Americans’ health and generating cost-savings for taxpayers and must be protected. We urge the Energy & Commerce Committee to amend the bill to protect Medicaid access for patients.

FOR IMMEDIATE RELEASE

Contact: Amy Simmons Farber, 202-309-0338

WASHINGTON D.C. – The National Association of Community Health Centers (NACHC) will kick off a Fly-In Event on May 13 on Capitol Hill to advocate for the protection of critical Medicaid services for Community Health Center (CHC) patients, as Congress works through budget reconciliation and debates key Medicaid policy proposals. This comes on the heels of thousands of CHC advocates sending more than 20,000 emails and calls to Congress in support of Medicaid. 

Representing 32.5 million patients nationwide, 16 million of whom are insured through Medicaid, a delegation of more than 100 CHC leaders will meet with policymakers from both sides of the aisle to bring attention to the vital partnership between CHCs and Medicaid. 

Not only is this partnership fundamental to improving Americans’ health, it also generates significant cost-savings for taxpayers. While CHCs care for one in five people in the U.S. who have health insurance through Medicaid, they only account for 2.3% of Medicaid spending. 

“Medicaid is the lifeblood of health centers. CHCs proudly serve more than 16 million people insured through Medicaid who include veterans, children, seniors, farmers, ranchers and working families,” says Kyu Rhee, MD, MPP, President and CEO of NACHC. “Cuts in Medicaid can trigger a cascade of health center site closures and service reductions that ultimately cost taxpayers more through increased emergency department visits, preventable hospitalizations, and more costly specialty care.” 

As such, hard-working Americans stand to lose quality healthcare and critical savings if Medicaid services are not protected. NACHC seeks to ensure policymakers understand the real-world impact these decisions have on the communities they serve. 

About the National Association of Community Health Centers

The National Association of Community Health Centers (NACHC) is the leading national innovative change agent collaborating with affiliates and partners to advance Community Health Centers as the foundation of an equitable health care system free from disparities and built on accessible, patient-governed, high-quality, integrated primary care.