Community Health Centers (CHCs) are the backbone of America’s primary health care system, serving at least 1 in 10 and up to 1 in 7 residents across every state, depending on annual visits or 3-year patient panels. From rural towns to dense urban neighborhoods, CHCs ensure communities have access to primary, dental, and behavioral health care, regardless of income, insurance status, or geography.

Nationally, CHC serves at least 34 million patients and up to 52 million. They play a particularly vital role for vulnerable populations:

• More than 1 in 4 Medicaid patients rely on CHCs for care.

• More than 1 in 5 uninsured patients receive care at CHCs.

• More than 1 in 17 Medicare patients turn to CHCs for their primary care needs.

CHCs are often the primary source of care for low-income patients, providing essential services regardless of ability to pay. This role is especially important in states that have not expanded Medicaid, where CHCs frequently serve as the only affordable access point for comprehensive primary health care.

CHC’s National Footprint 

Table 1 below highlights CHCs’ footprint in every state, showing the percentage of total residents, Medicaid, Medicare, and uninsured patients served by CHCs. It also illustrates that CHCs are not just local clinics. They are a national network delivering high quality care, deeply rooted in every state, and playing a central role in caring for Medicaid and uninsured populations.

High Impact, Low Cost 

Although CHCs care for a large share of the Medicaid population, they represent only a small fraction of Medicaid spending. Nationally, CHCs serve one in four Medicaid patients nationwide, yet account for less than 3% of total Medicaid expenditures. In 2024, total Medicaid spending reached $919 billion, while CHC Medicaid expenditures (reflected as Medicaid revenue) totaled $23 billion nationwide. This remarkable disparity highlights the cost-effectiveness and efficiency of CHCs, which deliver comprehensive, high-quality care to millions at a fraction of the program’s overall cost.  

In many states, CHCs serve as a major point of access for low-income families and people with complex needs at a fraction of what comparable care would cost elsewhere. (Table 2) By preventing costly emergency room visits and hospitalizations, CHCs generate significant savings for Medicaid while improving continuity, prevention, and outcomes across entire communities.

Rising Need and Financial Strain 

Looking ahead, the number of uninsured is likely to increase due to looming changes in Medicaid and Marketplace policies. At the same time, many CHCs are experiencing financial strain, with rising costs, workforce shortages, and thin operating margins threatening their ability to sustain services. On average, CHCs operate at negative margins below -2%, with one in 4 CHCs reporting less than -5%, making it increasingly difficult to maintain comprehensive primary care.

The Indispensable Role of CHCs

Today, Medicaid accounts for nearly half of all CHC revenue, while uninsured patients make up roughly 20% of those served nationwide. Despite these pressures, CHCs continue to form a network of essential primary care providers, keeping communities healthy. Without CHCs, the risk of higher mortality and higher health care costs will only increase.

Sustaining and supporting CHCs is crucial to maintaining a robust and accessible primary care system that reaches every corner of the country.

Table 1. The Reach of Community Health Centers Across Every State 

State	CHC Patients (1000s)	Total Population (1000s)	Pct. served by CHCs	Pct.  Medicaid served by CHCs	Pct. Uninsured served by CHCs	Pct. Medicare served by CHCs
AK	115	740	16%	29%	24%	17%
AL	344	5,158	7%	12%	21%	4%
AR	368	3,088	12%	21%	22%	9%
AZ	870	7,582	11%	23%	19%	7%
CA	6,172	39,431	16%	60%	26%	8%
CO	655	5,957	11%	27%	35%	6%
CT	453	3,675	12%	39%	33%	6%
DC	185	702	26%	92%	96%	18%
DE	41	1,052	4%	8%	19%	1%
FL	1,809	23,372	8%	15%	19%	3%
GA	754	11,181	7%	9%	15%	5%
HI	159	1,446	11%	30%	30%	7%
IA	254	3,241	8%	24%	30%	3%
ID	241	2,002	12%	22%	28%	10%
IL	1,502	12,710	12%	36%	33%	5%
IN	820	6,924	12%	34%	22%	7%
KS	321	2,971	11%	18%	35%	7%
KY	701	4,588	15%	40%	29%	10%
LA	506	4,598	11%	34%	23%	7%
MA	870	7,136	12%	26%	66%	8%
MD	375	6,263	6%	14%	20%	4%
ME	219	1,405	16%	29%	24%	16%
MI	693	10,140	7%	18%	18%	5%
MN	169	5,793	3%	8%	18%	1%
MO	665	6,245	11%	33%	24%	5%
MS	316	2,943	11%	16%	32%	10%
MT	130	1,137	11%	19%	22%	10%
NC	799	11,046	7%	12%	24%	6%
ND	36	797	5%	9%	16%	3%
NE	123	2,005	6%	14%	29%	2%
NH	95	1,409	7%	10%	23%	7%
NJ	621	9,501	7%	18%	23%	2%
NM	328	2,130	15%	31%	35%	12%
NV	130	3,267	4%	8%	10%	2%
NY	2,502	19,867	13%	31%	32%	8%
OH	1,012	11,883	9%	25%	17%	6%
OK	347	4,095	8%	17%	13%	7%
OR	433	4,272	10%	37%	18%	7%
PA	1,089	13,079	8%	19%	23%	6%
PR	474	3,203	15%	20%	26%	8%
RI	220	1,112	20%	49%	44%	11%
SC	450	5,479	8%	12%	23%	7%
SD	124	925	13%	18%	27%	12%
TN	438	7,228	6%	10%	21%	4%
TX	1,901	31,291	6%	10%	12%	3%
UT	144	3,504	4%	5%	22%	3%
VA	422	8,811	5%	9%	15%	4%
VT	211	648	32%	51%	86%	32%
WA	1,276	7,958	16%	51%	34%	9%
WI	293	5,961	5%	18%	16%	2%
WV	584	1,770	33%	62%	55%	27%
WY	35	588	6%	7%	11%	5%
US	33,793	343,314	10%	26%	22%	6%

Source: 2024 Uniform Data System (HRSA) and Census.

Note: Excludes US Territories except Puerto Rico due to lack of comparable data.

Table 2. High Value of CHCs in Every State (Medicaid) 

State	Pct.  Medicaid served by CHCs	CHC as % of Medicaid Spending		State	Pct.  Medicaid served by CHCs	CHC as % of Medicaid Spending
AK	29%	7.5%		MT	19%	3.4%
AL	12%	1.1%		NC	12%	0.8%
AR	21%	1.6%		ND	9%	1.2%
AZ	23%	3.5%		NE	14%	1.2%
CA	60%	5.0%		NH	10%	1.4%
CO	27%	2.7%		NJ	18%	1.1%
CT	39%	2.8%		NM	31%	1.7%
DC	92%	4.9%		NV	8%	1.2%
DE	8%	0.5%		NY	31%	1.7%
FL	15%	1.7%		OH	25%	1.8%
GA	9%	0.7%		OK	17%	1.5%
HI	30%	5.7%		OR	37%	4.6%
IA	24%	1.6%		PA	19%	1.5%
ID	22%	2.9%		RI	49%	5.0%
IL	36%	2.3%		SC	12%	1.6%
IN	34%	2.6%		SD	18%	1.6%
KS	18%	1.9%		TN	10%	0.8%
KY	40%	2.3%		TX	10%	1.0%
LA	34%	1.8%		UT	5%	1.3%
MA	26%	2.5%		VA	9%	0.7%
MD	14%	1.4%		VT	51%	3.0%
ME	29%	2.4%		WA	51%	6.5%
MI	18%	1.5%		WI	18%	1.8%
MN	8%	0.5%		WV	62%	4.4%
MO	33%	3.1%		WY	7%	1.2%
MS	16%	0.5%		US	26%	2.5%

Source: 2024 Uniform Data System (HRSA), Census, and CMS Medicaid expenditures (estimates from KFF). 

Note: Excludes US Territories due to lack of comparable data.

With an increase in both prescription use and drug prices, many states sought to improve access to affordable medications in their 2025 legislative session, including bills targeting the 340B program. The 340B program is vital for safety net providers, like Community Health Centers (CHCs), to purchase outpatient drugs at significantly reduced costs. CHCs are the largest primary care network nationwide and serve as the safety net for millions of patients in underserved communities. However, ongoing actions by drug manufacturers threaten patient access to essential medicines and divert savings away from patient care. CHCs are losing mission-critical funds due to discriminatory contracting practices by pharmacy benefit managers (PBMs) and contract pharmacy restrictions. 

This past legislative session saw a flurry of activity protecting contract pharmacies, and a novel but growing push for more data reporting from covered entities on the state level. So far, 37 states have enacted laws to protect CHC 340B savings, and 11 have passed laws with 340B data reporting requirements. This blog provides a brief overview of the trends from the states’ legislative sessions in 2025. For more information, see NACHC’s state legislation 340B tracker. 

More Contract Pharmacy Protections Will Improve Access to Affordable Medications

Many CHCs lack the financial resources to operate an entity-owned pharmacy and depend on contracts with local pharmacies to fill patient prescriptions. Unfortunately, drug manufacturers have imposed restrictions that have hindered CHC’s use of contract pharmacies. Arkansas became the first state to pass legislation in 2021 prohibiting manufacturers from restricting access to 340B discounted drugs at contract pharmacies. As of the publication of this blog, 21 states have enacted these laws, with many passing in 2025. While most contract pharmacy bills appear similar, there are some differences among the 2025 bills:  

• Tennessee’s law only applies to drugmaker restrictions placed after July 2025. 

• New Mexico’s protections only apply to CHCs. 

• Some state bills included additional provisions around reporting requirements and hospital price caps (the maximum that can be charged for a drug).  

While federal action on contract pharmacy protections remains stalled, states can pass legislation to protect contract pharmacies and ultimately improve patients’ access to affordable medications.  

Additional Reporting Requirements May Increase Administrative Burden on Pharmacies 

In addition to the required annual reporting to HRSA’s Uniform Data System (UDS), CHCs also report data to stay compliant with the 340B program. CHCs are also statutorily required to reinvest every penny of 340B savings directly into patient care. As scrutiny has increased on how covered entities use 340B savings, nearly a dozen states have passed legislation in 2025 with 340B data reporting requirements, both through standalone and inclusions in contract pharmacy protection bills. These requirements vary by state and differ in which entities need to report and what information they must provide, including information on how 340B savings are used to benefit patients, total 340B prescription cost, and information on their contract pharmacies: 

• Idaho, Indiana, Ohio, Rhode Island, and Hawaii all passed 340B reporting requirements for CHCs in 2025. 

• Colorado, Maine, and Vermont’s 340B reporting requirements also passed, but only applied to hospitals. 

CHCs support transparency in the 340B program. However, these requirements can add administrative burden to safety net providers with limited financial resources and an existing, strained workforce. Through the health center program, CHCs already report data about patient population, sliding fee discounts, and other services that directly support patient care. In many states, implementation has only just begun, so the true burden has yet to be seen. As CHCs differ from other providers in the 340B program, the data collected and shared should continue to tell the story of how CHCs are responsible stewards of the 340B program. 

Additional Legislation and State Budget Provisions Could Predict Future Trends 

Although there were observable trends in state 340B actions in 2025, emerging activities in some states may be a sign of proposals to come: 

• Indiana’s state budget included a provision that would allow the state Medicaid agency to determine whether 340B drugs prescribed to a small subset of Medicaid managed care patients would get an upfront 340B discount or be subject to a rebate.  

• Connecticut’s bill, which died in committee, would have allowed the state to withhold Medicaid funding from CHCs if they did not report how 340B savings are used to benefit patients.  

States may look for other ways to creatively cut down on state spending through targeting the 340B program.  

What’s next? 

While these trends represent the first half of 2025, 2026 may see: 

• Continued lawsuits: A signed bill does not mean a done deal; many states have faced lawsuits from drug manufacturers arguing issues like federal preemption, due process, and unconstitutional vagueness. We will continue seeing rulings and legal challenges that further shape the landscape. 

• Legislation Carryover: Some states do not carry over introduced bills. As the 2025 session concludes, lawmakers must reintroduce bills for any further action. However, 2025 marked the start of the ‘odd year carryover’ for some states, meaning bills that have not been voted on in the 2025 session could still be acted upon.  

• Federal action: As we await more information on the 340B rebate pilot program, the future of how CHCs can use 340B savings to support patient care is uncertain. We may also see increased federal activity and appetite for 340B-related bills on Capitol Hill.  

NACHC Resources 

NACHC’s State and Regulatory Affairs teams are here to support Primary Care Associations (PCAs) and CHCs as they work to protect 340B savings. NACHC hosts monthly 340B calls, sharing federal, state, and litigation updates and focus topics. Contact Regulatory Affairs at [email protected] if you have any questions. 

The CBO projects the One Big Beautiful Bill Act (HR1) will increase the number of uninsured by at least 10 million in 2034. When combined with the scheduled expiration of the Affordable Care Act’s enhanced premium tax credits, the total increase in the uninsured population is expected to reach 14.2 million. 

Community Health Centers (CHCs), which serve over 6 million uninsured patients, representing at least 1 in 5 uninsured nationally, will be on the front lines of absorbing this coverage loss. Using state-level projections from KFF and data from 2024 CHC and Census data, we estimate CHCs will see an increase of at least 1.9 million uninsured patients under KFF’s lower-bound projection and as many as 4.2 million under its higher-bound projection by 2034.  Most of this increase is expected to come from individuals losing Medicaid coverage.

This range reflects the application of state-specific uninsured projections to the proportion of uninsured currently served by CHCs. These additional patients reflect both currently insured CHCs patients who are expected to become uninsured and new patients who may turn to CHCs after losing coverage. These estimates provide a picture of potential added demand and do not reflect CHCs’ actual capacity to serve this many additional patients.

If realized, these shifts could bring CHCs’ total uninsured patient load to 8-10 million annually by 2034. CHCs are already under strain, managing a growing uninsured population while contending with persistent workforce shortages and constrained funding. This pressure is compounded by the fact that CHCs are currently operating at an average margin of -2% (2024 CHC data), with one quarter of CHCs operating below -5% (unpublished audited 2024 financial CHC data).

Taken together, this analysis underscores the urgent need for both state and federal policy responses to ensure CHCs can continue providing high-quality, comprehensive primary care, including behavioral and oral health, to the communities that rely on them most.

State-specific Projections of Additional Uninsured Patients at CHCs by 2034

	CHC uninsured (2024)	Pct state uninsured served by CHCs (2024)	Lower-bound Additional CHC Uninsured (2034)	Higher-bound Additional CHC Uninsured (2034)
AL	86,000	21%	8,000	39,000
AK	18,000	24%	5,000	9,000
AZ	149,000	19%	49,000	101,000
AR	62,000	22%	17,000	37,000
CA	606,000	26%	314,000	550,000
CO	164,000	35%	39,000	85,000
CT	69,000	33%	33,000	59,000
DE	14,000	19%	5,000	11,000
DC	30,000	96%	23,000	38,000
FL	481,000	19%	84,000	364,000
GA	193,000	15%	18,000	91,000
HI	14,000	30%	9,000	16,000
ID	51,000	28%	8,000	17,000
IL	283,000	33%	115,000	214,000
IN	111,000	22%	35,000	78,000
IA	52,000	30%	18,000	39,000
KS	86,000	35%	7,000	27,000
KY	90,000	29%	47,000	79,000
LA	79,000	23%	43,000	93,000
ME	18,000	24%	6,000	10,000
MD	77,000	20%	27,000	51,000
MA	131,000	66%	92,000	171,000
MI	94,000	18%	42,000	90,000
MN	52,000	18%	23,000	41,000
MS	89,000	32%	9,000	44,000
MO	115,000	24%	29,000	68,000
MT	21,000	22%	6,000	14,000
NE	40,000	29%	9,000	20,000
NV	38,000	10%	8,000	15,000
NH	14,000	23%	4,000	9,000
NJ	171,000	23%	54,000	115,000
NM	75,000	35%	24,000	43,000
NY	315,000	32%	207,000	347,000
NC	225,000	24%	53,000	136,000
ND	7,000	16%	2,000	5,000
OH	134,000	17%	43,000	100,000
OK	61,000	13%	13,000	30,000
OR	39,000	18%	28,000	46,000
PA	174,000	23%	67,000	130,000
RI	22,000	44%	13,000	23,000
SC	110,000	23%	10,000	55,000
SD	20,000	27%	2,000	7,000
TN	142,000	21%	11,000	54,000
TX	636,000	12%	44,000	222,000
UT	62,000	22%	13,000	41,000
VT	23,000	86%	10,000	19,000
VA	87,000	15%	34,000	63,000
WA	173,000	34%	101,000	179,000
WV	55,000	55%	25,000	51,000
WI	50,000	16%	9,000	22,000
WY	6,000	11%	200	1,000

Source: 2024 UDS, KFF state uninsured projections based on CBO estimates of 10 million and 14.2 million additional uninsured by 2034. Excludes US territories served by CHCs due to lack of comparable projections.

October 8th is Health Cares About Domestic Violence Day. Register by October 8th at midnight for Building Health Center Responses to Domestic Violence (a 4-session Community of Practice), and join us on Wednesday, October 8th (8am HST/11am PST/12pm MST/1pm CST/2pm EST) for a Health Cares About Domestic Violence Day webinar! 

A new patient dropped into my health center complaining of painful urination. While waiting for her urinalysis results during the visit, I obtained her “history of present illness”, and talked to her about healthy and unhealthy relationships, how relationships can impact health – sometimes leading to symptoms like hers. I offered her safety cards with information on how to get help (both locally and nationally) if she or someone she knew were ever in a situation where a relationship caused health harm (physical, emotional, psychological) or if there were any safety concerns. 

She looked me straight in the eye, and replied, “Wow, thank you. This is not going on for me right now…but I wish I had this information a few years ago when I really needed it, and was in a really bad relationship…I’m going to take these because I have some friends who I think are experiencing the same thing.” 

Why Community Health Centers should treat domestic violence as a health issue

Domestic violence is a health issue. Health centers are primed to help patients by reducing isolation and improving outcomes for safety and health.

In a 2021 survey of National Domestic Violence Hotline callers, 61% noted that they had current health needs related to abuse, 41% were somewhat or extremely likely to be comfortable sharing their abuse experience with a health care provider, and 53% reported that an abusing partner had controlled or restricted their health care access.  

Resources to learn more

Health Partners on IPV + Exploitation (Futures Without Violence), a National Technical Assistance Program, offers free resources to health center staff to effectively prevent and help your patients experiencing domestic violence. Examples of these resources include safety card tools, smart tools for OCHIN Epic and eClinicalWorks platforms; and health IT resources that explore customization, privacy, and confidentiality. 

Stay connected to Health Partners on IPV + Exploitation for webinars, new resources, and other opportunities, by scrolling to the bottom of www.healthpartnersipve.org and signing up for the monthly newsletter, Catalyst for Change. 

Building trust with patients to support overall health

That day, in addition to a prescription for a course of antibiotics, this patient left my health center knowing that she could talk to us about domestic violence, we could treat any health and mental health concerns, and we could help connect her to other community partners. We built her trust for future interactions with the health care system, and got crucial information into her hands and out into the community overall. Let’s show our patients and communities that Health Cares About Domestic Violence! We encourage and invite you to participate in the 26^th Annual Health Cares About Domestic Violence (HCADV) Day! Check out the HCADV Day action kit for ideas on activities you can organize in honor of HCADV Day this year and beyond.

Lead author: Kimberly S.G. Chang, MD, MPH is a Family Physician at Asian Health Services, and is the current Speaker of the House for NACHC.

Contributing authors: Anna Marjavi is the Director of Health Partners on IPV +Exploitation. Kenede Pratt-McCloud is a Program Assistant at Futures Without Violence on the Health Team. Jake Sese, MPH is a Program Associate for Futures Without Violence on the Health Team.

While Community Health Centers (CHCs) are recognized as the nation’s largest primary care network, less is known about the ways they often lead as drivers of improvement in health care and support services. Through initiatives like the Best and Promising Practices in Health Center Transformation, NACHC highlights the great work happening across health centers, which serve at least 1 in 10 Americans and up to 1 in 7.

Identifying Care Team Best Practices from CHCs Across the Country 

In July 2025, NACHC’s Elevate national program launched a call for health center applicants to share their most promising and proven practices driving transformation toward the Quadruple Aim: better health outcomes, improved patient and clinician experience, and lower costs. We received over 100 submissions spanning Care Delivery, Infrastructure, and People  – domains in the Value Transformation Framework – an organizing model for health center systems change.  

NACHC selected 27 awardees across 18 states for recognition. Awards ranged from $1,000 – $6,000, and submissions highlighted innovative processes, protocols, and programs that have made a demonstrated impact. 

With many impressive programs to choose from, we are pleased to highlight three of our top winners:

Care Navigators, Ambassadors, and Community Health Workers 

Siloam Health of Nashville, TN, developed an accredited, evidence-based Community Health Worker (CHW) program to improve chronic disease outcomes in hard-to-reach communities in central Tennessee, with implications for preventive care, including cancer screening.  

Partnering with IMPaCT (a Community Health Worker program), they recruited CHWs from the communities they serve and trained them in behavioral health, motivational interviewing, and health coaching, delivering culturally tailored care in Spanish and Arabic.  

The program includes quality standards, fidelity monitoring, and biweekly data-driven learning sessions to optimize workflows.  

Serving over 600 patients annually, Siloam’s CHW program has driven significant improvements in A1c, blood pressure, weight, and care goal achievement. Though focused on chronic disease, these trusted CHWs assist patients through cancer treatment and are well positioned to expand their work to preventive care and cancer screening navigation in underserved populations that face greater barriers of trust and access. 

Quality Improvement Commitments  

Bay Community Health (BCH) of West River, MD, successfully closed care gaps in diabetes management by integrating point-of-care A1C testing into routine visits, strategies for delivering immediate results and timely clinical action that are now being applied to cancer screening.  

By adopting technology that uploads results directly into the EHR, BCH reduced documentation errors from 12.5% to 0.9%, and decreased the percent of patients with uncontrolled or undocumented A1Cs from 26% to 17% within one year.  

Continuous improvement was driven through repeated Plan-Do-Study-Act (PDSA) cycles, staff retraining, and monthly quality audits to sustain accuracy and adherence. Building on this success, BCH is now applying these strategies to cancer screening: piloting in-visit FIT testing and same-day mammography scheduling to minimize missed opportunities and enhance preventive care access.  

Data Management and Integration 

The Asian American Health Coalition (AAHC) of Houston, TX, significantly enhanced the accuracy and usability of its cancer screening data through focused data hygiene and staff education efforts. Early on, AAHC discovered discrepancies between cancer screening reports from different data systems, which raised concerns about the reliability of outreach and improvement efforts.  

To address these discrepancies, the Health Informatics Analyst initiated a monthly data review process targeting one or two UDS measures at a time. These reviews clarified reporting logic and identified gaps in documentation, electronic health record (EHR) setup, and vendor configurations. Correcting missing LOINC codes in lab results, for example, led to a 5% improvement in screening compliance.  

As staff deepened their understanding of electronic clinical quality measures, outreach efforts became more precise, avoiding redundant follow-up with already-screened patients. This ongoing process boosted confidence in quality reporting, including UDS and Healthcare Effectiveness Data and Information Set (HEDIS) reports and established a sustainable, team-driven approach to continuous data quality improvement with a smarter foundation for cancer screening performance and more effective patient engagement. 

We honor these CHCs for their commitment to advancing excellence in community health. NACHC is proud to celebrate and learn from these efforts, which showcase how health centers are addressing the needs of their communities.  

Acknowledgements: 

This programming is supported by the Centers for Disease Control and Prevention Cooperative Agreement Number 6 NU38PW000015-01-02 as part of a financial assistance award totaling $800,000 with 100% funded by CDC/HHS. The contents of this presentation are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. 

This article originally appeared on the The Weitzman Institute website on August 5, 2025, and is reprinted with permission.

Across the country, Community Health Centers (CHCs) are widely recognized for serving 1 in 10 people. This figure, based on 33.9 million patients from 2024 Uniform Data System (UDS) reports, is an impressive statistic, but it understates the reach or value of CHCs. New analysis suggests that when considering unduplicated patients over a multi-year period, the true number of people CHCs support is millions higher.

The Weitzman Institute conducted a review of patient records from a single large CHC based in Connecticut. Over a three-year span from 2020-2023, the data showed that the CHC reached far more individuals than its annual patient count would suggest. When this kind of multi-year patient panel estimate is extrapolated to the national level, it suggests that CHCs may serve as many as 1 in 7 people or 52 million patients with active medical charts.

Additional reporting from high-performing CHCs nationally give further credence to the broader reach of CHCs. One CHC in the Pacific Northwest reported 57,000 unduplicated patients over the three-year span of 2022-2024, compared to 48,000 in 2024 alone. This means the CHC is reporting only 84% of active patients when relying on a single-year measure. Another CHC in the same region reported 195,000 unique patients in 2023 and 308,000 over the three-year period of 2020-2023, further highlighting the limitations of annual reporting in capturing the full scope of CHC impact.

This matters because many patients do not use primary care services every year. According to a 2022 federal survey of CHC patients, approximately 30% wait more than a year for a general exam. And approximately 73% of those who waited got their exam at the CHC.

CHCs are designed to meet patients where they are offering accessible care when it is needed most. The HRSA survey further reports more than two out of three CHC patients have been going to their CHC for at least three years. Only 15% of patients are relatively new to the CHC.

These episodic but meaningful interactions are vital to individual and community health, yet they go unrecognized in annual reporting or funding formulas. Insurers and value-based care models are increasingly accounting for this reality by using two-three year lookback periods to attribute patient outcomes to providers. This approach reflects the way people actually use care and provides a more accurate picture of provider-patient relationships. The focus on annual visits and yearly headcounts underrepresents the actual demand and reach of CHCs.

A broader time horizon would offer a more accurate accounting of the role CHCs play in stabilizing access to care for patients who may move in and out of insurance or face chronic instability in other parts of their lives. Capturing and communicating this longitudinal view is essential because it reinforces the importance of sustained investment in CHCs, not only as medical providers but as trust institutions that patients return to throughout their lives.

This finding points to an urgent need to revisit how the health care system measures access and allocates resources. While further research across diverse settings is necessary, the early evidence is clear: CHCs serve far more people than annual statistics suggest. This number is particularly important to get correct when resources are limited because underestimating their true footprint risks underfunding the very primary care infrastructure that serves as the front line for millions of underserved populations. Ensuring that metrics fully capture CHC reach is essential to guiding smarter, more sustainable investments in the nation’s largest primary care safety net– that will be an article for a future piece.

To follow the work of the Weitzman Institute and the Moses/Weitzman Health System, click here.