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This article was published as part of NACHC’s Dr. John W. Hatch Center for Science.

Community Health Centers (CHCs) provide comprehensive, whole person care to nearly 34 million Americans across 17,000 communities. Nine in 10 patients are low-income, and the majority either lack insurance or rely on Medicaid. These CHCs operate in areas designated as medically underserved by the federal government, often serving as the main or only source of primary care for entire communities. Despite operating with limited resources, CHCs have demonstrated strong performance on national benchmarks for clinical quality while generating measurable savings for the broader health system.

Recent federal data confirms continued excellence in many areas but also highlights growing operational pressures. Rising costs, workforce shortages, and infrastructure limitations threaten their quality achievements. Long-term, targeted investments are urgently needed to preserve CHCs’ high performance and broader value.

Consistent high performance on core clinical quality measures

According to the 2024 Uniform Data System (UDS), CHCs that receive federal grants under Section 330 continue to meet or outperform many national benchmarks, even while serving populations with complex health needs. The following quality measures reflect data only from 1359 grantees and exclude 153 look-alike health centers, which meet CHC grant requirements but do not receive Section 330 funding, to ensure comparability.

  • Blood pressure control (< 140/90 mmHg) among adults with hypertension reached 67%, surpassing the national Medicaid median of 61%.
  • Cervical cancer screening remained steady at 55%, generally comparable to Medicaid plans.
  • Breast cancer screening increased from 45% in 2020 to 54% in 2024, aligning with the Medicaid median of 53%.
  • Poor diabetes control (patients with A1c values above 9%) dropped from 36% in 2020 to 28% in 2024, outperforming the Medicaid median of 38%.

These results reflect a long-standing commitment to patient-centered, team-based care. CHCs integrate primary care with behavioral health, dental health, vision care, pharmacy services, and enabling services such as case management and translation, which together support patient adherence and continuity. However, this innovative model of care is increasingly strained by major turnover and retention challenges and technology gaps that hinder timely data integration and care coordination. Without operational investments, sustaining or expanding quality gains will become increasingly difficult.

Cost savings and system impact

Beyond clinical quality, CHCs generate measurable value for the broader health care system. Independent analyses have consistently found that CHCs reduce total system costs by avoiding unnecessary emergency department visits, hospitalizations, and preventable complications of chronic disease.

  • CHCs are estimated to save $39 billion annually. The CBO also confirmed CHCs generate significant savings.
  • Per patient, CHCs deliver care at a cost that is $800 to $1400 less per year for child and adult Medicaid enrollees than in other settings.
  • Studies show that CHC patients enrolled in Medicaid have lower rates of hospital admissions and specialty care use.
  • CHCs also contribute to a reduction in premature mortality.

These outcomes are driven by CHCs’ embedded presence in the community they serve, and their ability to provide early, coordinated, and preventive care.

Limitations of the current funding environment

Despite their track record, CHCs operate under persistent financial constraints that limit their ability to scale services or invest in modernization. CHC funding has remained relatively flat, while CHC patient volume continues to increase each year.

Federal funding is also subject to short-term extension, which impedes multi-year planning and limits the ability to implement large-scale quality improvement initiatives. The lack of long-term funding hinders the adoption of innovations such as clinical decision support, advanced analytics, and population health management tools.  These limitations are particularly acute in rural and high-need urban communities, where the absence of robust infrastructure exacerbates existing disparities.

Actions needed to build on CHCs’ clinical quality achievements

Unlike other sectors, CHC quality reporting includes all patients, regardless of insurance status. This creates an unfiltered view of system performance that few other sectors provide. It creates a uniquely complete picture of care performance but also exposes CHCs to heightened scrutiny, as their outcomes are not adjusted for the higher social or clinical complexity of the populations they serve.

To preserve and build on quality performance CHCs have achieved, several steps are essential:

  • Secure stable, multi-year federal funding for CHCs.
  • Invest in the CHC workforce.
  • Support data and technology modernization, especially in rural areas.
  • Ensure quality programs account for operational realities in safety net settings and avoid penalizing providers that care for large numbers of uninsured and Medicaid patients.

These actions are not intended to replace accountability, but to enable meaningful and sustainable improvement in clinical outcomes, system savings, and care delivery at scale.  Quality cannot, and must not, wait.

The 2024 Uniform Data System (UDS) offers a revealing snapshot of Community Health Centers (CHCs) navigating another year of uncertainty and transition. While the data reflect continued growth and resilience, they also highlight mounting financial and operational pressures that challenge CHCs’ ability to sustain and expand care. Below, we summarize key observations from the latest data and discuss what they mean for CHCs, patients, and policymakers.

The Good: Access Expanded

Patient volume grew again in 2024, with CHCs now serving nearly 34 million people, up from 32.5 million in 2023. This growth underscores the essential role CHCs play as primary care anchors for communities with significant health needs.

Additional signs of improved access include:

  • Expansion of look-alikes: The number of look-alikes (LALs), organizations that meet federal requirements for CHC grants but do not receive grant funding, increased from 133 to 153. This expansion extended care into additional areas of high need.  The number of patients served by LALs increased from 1.2 million to 1.5 million between 2023 and 2024.
  • Shifts in payor mix: Across grantees and LALs, patient growth was led by approximately 823,975 privately insured patients, followed by 290,168 uninsured, and 227,601 Medicare patients.
  • Slower per patient cost growth: Per patient costs increased by less than 7%, compared to 10% in prior years. This slowdown likely reflects constrained hiring, tighter financial controls, and flat or reduced revenues in many CHCs.
  • Stable quality performance: Quality of care remained consistent with 2023 levels, indicating that care delivery has remained steady despite financial and operational stress.

The Bad: Financial Strains Deepen

Despite growing patient volume, CHCs reported worsening financial conditions. The national average operating margin fell to -2.4%, with a margin of –2.1% for grantees. Although overall cost increases slowed, they still outpaced per patient revenue growth, which rose by only 2.5%.  

Key contributing factors include:

  • Expired COVID funding: Pandemic-era supplemental funding expired and was greatly diminished entering 2024, with CHCs losing an estimated $1.5 billion.
  • Medicaid patient losses: Despite a nominal increase of 16,467 Medicaid patients across all grantees and LALs, grantees experienced a net loss of 65,739 Medicaid patients.
  • Decline in adult Medicaid patients: Grantees experienced a net loss of 71,500 adult Medicaid patients, reflecting the effects of Medicaid unwinding and administrative churn.
  • More uninsured patients: Grantees reported an increase of 256,351 uninsured patients. Notably, children accounted for 56% of this growth.

For the first time in several years, the number of grantees dropped slightly from 1,363 to 1,359 between 2023 and 2024.  The reasons for the decline are unclear, as current data does not provide sufficient detail to determine if this reflects actual closures, organizational mergers, or other factors.

The Urgent: Medicaid Enrollment Drops in Most States

The most concerning trend in the 2024 data is the widespread decline in adult Medicaid enrollment in many states (Table 1). This was largely driven by the unwinding of continuous coverage requirement that had been in place during the public health emergency.   Beginning in April 2023, states began terminating Medicaid coverage, with a significant number disenrolled due to ineligibility, confusion, paperwork issues, system backlogs, or failure to complete new eligibility forms. These coverage disruptions have real consequences for continuity of care and financial stability for CHCs.

In Georgia, where Medicaid work requirements were implemented in 2023, adult Medicaid enrollment among grantees declined by 13.6%. This drop in coverage resulted in a $6.5 million loss in Medicaid revenue. While not the steepest decline nationally, it illustrates how new eligibility requirements, layered on top of the redetermination process, can intensify patient loss. Nationwide, health center grantees reported a net decline in adult Medicaid patients as the demand for care continued to rise.

Looking ahead, the One Big Beautiful Bill Act (OBBBA), enacted in July 2025, mandates work requirements nationwide. Unless these are paired with automatic exemptions and modernized eligibility systems, this policy is likely to accelerate Medicaid disenrollment and lead to more people losing insurance, undermining coverage gains from the past decade.

Note: Excludes look-alikes. US estimate includes the US territories.

Twelve states reported a decline in CHC Medicaid revenue in 2024. The most significant percentage decline occurred in North Dakota (-11.0%), New York (-11.8%), and Wyoming (-14,8%).  In terms of dollar losses, New York CHCs reported the largest shortfall at $204 million, followed by $22 million in Texas, $14 million in Michigan, and nearly $11 million in West Virginia. Altogether, CHCs across the 12 states reported a Medicaid loss of $306 million.

Note: Excludes look-alikes. US total estimate includes the US territories. Revenue estimates reflect payments collected for both adult and child beneficiaries.

Call for Policy Action: Growth Must be Match by Stability

The 2024 data reflect a system that continues to expand access while facing significant financial strain. To sustain progress, several key policy actions are needed:

  • Renew and expand CHC funding, which accounts for 10% of CHC revenue. Timely renewal is essential to prevent service disruptions. Long-term funding stability will also be essential as OBBBA policies increase demand and coverage volatility.
  • Protect Medicaid coverage by ensuring consistent application and enforcement of federal exemptions that safeguard eligible beneficiaries are not disenrolled because of procedural obstacles or eligibility barriers. Simplifying renewals and reducing administrative burdens on patients and providers is vital.
  • Increase national investment in primary care, recognizing it still receives less than 5% of national health spending. Strategic investment in workforce development and digital infrastructure, including telehealth platforms, and care coordination are necessary to strengthen capacity.

Recommendations for CHCs

To manage current challenges and sustain their mission, CHCs may consider the following steps:

  • Plan for sustained financial constraints. With temporary funding greatly reduced and long-term CHC funding renewal still pending, CHCs should continue preparations for ongoing budget strain. Financial recovery is likely to be uneven and prolonged.
  • Closely monitor state-level Medicaid changes. Understanding how states implement work requirements, define exemptions, and handle renewals will be critical for enrollment strategy and patient retention.  Georgia’s and Arkansas’ experience offers a cautionary lesson. Engagement with state Medicaid agencies managed care organizations will be essential to minimize patient losses and administrative burdens.
  • Focus investment on core capacity. CHCs should continue building clinical, operational, and technological capacity to ensure access and quality can be maintained under pressure.
  • Strengthen strategic partnerships to fill service gaps. Collaborating with behavioral health providers, public agencies, and technology organizations can help extend reach and improve services.
  • Use internal and shared data to guide decisions. Tracking patient trends, payor mix, and operational performance will support more effective planning and help advocate for necessary policy and funding changes.  

What Federal and State Policymakers Can Do

Community Health Centers continue to reach more people and provide stable care under challenging conditions. However, without sustained funding, protective policies, and targeted investments in primary care, CHCs risk becoming overextended. Federal and state policymakers must provide adequate funding and implement Medicaid safeguards to ensure CHCs can continue delivering essential, affordable care to the communities that rely on them.

Thirty five years ago, the Americans with Disabilities Act (ADA) was signed into law, in July 1990. This anniversary is an opportunity to honor the contributions, culture, and experiences of people with disabilities of the more than 61 million adults in the United States living with a disability. It also serves as a reminder to promote accessibility and dignity in every facet of life – including health care.

Community Health Centers (CHCs) have long been at the forefront of addressing barriers to care, especially for underserved populations. The mission of CHCs is to improve health access and outcomes for all people, including individuals with disabilities.

Health Care Barriers for People with Disabilities

Despite some advances, people with disabilities continue to face significant barriers when seeking care:

  • According to the CDC, adults with disabilities are more than twice as likely to report unmet health care needs due to cost (32% vs. 12%).
  • A 2022 report from the National Council on Disability found that only 40.7% of practicing physicians felt “very confident” in their ability to provide the same quality of care to patients with disabilities as they do to others.
  • Furthermore, 72% of adults with disabilities report not receiving necessary accommodations in health care settings, a gap that can lead to delayed diagnoses, inadequate treatment, and preventable complications.

These challenges are often compounded for individuals with intellectual and developmental disabilities (IDD), who may experience communication barriers, inaccessible exam equipment, or care environments that lack sensory-friendly adaptations.

Health Access and Disability: The CHC Response

Across the CHC network, providers are rising to meet this challenge by embedding whole-person care into care delivery. Achievable Health, a federally qualified health center in California, is a powerful example. Their model of care centers on the needs of individuals with IDD, tailoring their approach to accommodate a wide range of abilities and preferences.

Achievable Health’s implementation of accessible non-clinical factors of health screening tools allows them to identify the unique barriers affecting their patients outside the clinic walls. Their workflows are adapted to ensure that accommodations are not an afterthought but an integral part of high-quality care. The result? Equal or better health outcomes for patients with IDD, demonstrating that intentional accessibility efforts drive measurable impact.

NACHC’s Role: Supporting Healthcare Access

NACHC is committed to supporting CHCs in building systems of care that improve health for all people. Through training, resource development, and communities of practice, NACHC is helping health centers:

  • Implement non-clinical factors of health screening tools that capture the unique needs of individuals with disabilities.
  • Develop partnerships with disability-focused organizations to improve referral systems and response.
  • Build provider confidence through education and peer learning opportunities focused on whole-person care.

Whole-Person Care at NACHC’s 2025 Community Health Conference & EXPO

This Disability Pride Month let’s celebrate progress and push further! Ensuring access to person-centered care for all is not just the right thing to do; it’s central to the mission of Community Health Centers.

NACHC’s 2025 Community Health Conference (CHI) & EXPO will feature engaging sessions focused on advancing whole-person care for every community. We invite you to be part of the conversation in Chicago on Tuesday, August 19 at 9:45 AM CT for:

Invisible No More: Ensuring Health Access for People with Intellectual and Developmental Disabilities

This session will highlight how accessible screening strategies and care models can help close gaps in care for individuals with IDD. Attendees will gain practical tools for adapting workflows, training staff, and building community partnerships—approaches that improve outcomes for patients with IDD and can enhance care across all populations.

Explore the full conference schedule and register today: NACHC’s 2025 Community Health Conference & EXPO

With support from the Robert Wood Johnson Foundation, the NACHC launched the 2025 Design Sprint initiative to position Community Health Centers (CHCs) as partners of choice for innovative, cross-sector collaborations aimed at advancing health outcomes. Rooted in the Stanford’s d. School’s Design Thinking Model, the initiative offered a focused period of training, technical assistance, and peer-to-peer learning to drive creative problem-solving, and systems change. 

Through this human-centered design approach, participants strengthened strategic partnerships, improved data sharing, and addressed non-clinical factors that impact health—ultimately working to improve outcomes for individuals with complex health and social needs.

The Design Sprint Journey

For five transformative months, four community health centers across the country joined forces with cross-sector partners to tackle one pressing question:


How can we better serve individuals in our communities facing complex social and health needs?

United by a shared commitment to person-centered care, each team focused on a specific unmet social need, ranging from food insecurity to homelessness, deeply rooted in the communities they serve. These weren’t abstract challenges; they were real issues affecting patients’ ability to thrive. 

Primary Health Care tackled a challenge familiar to many providers: EHR “click fatigue.” Partnering with the Iowa Community HUB, they streamlined the referral process by integrating one-click functionality directly into the clinical workflow. This innovation not only lightened the provider burden but made it easier and faster to connect patients to critical community services. In the words of one team member, the result was a “ripple effect” of positive change – for both care teams and patients. 

The Primary Health Network took a relationship-first approach to serving people experiencing homelessness. Working alongside the City Rescue Mission and The Cornerstone of Beaver County, they recognized that before they could offer care, they needed to build trust in their community. For months, a Public Health Nurse simply showed up, spending time in the kitchen and common spaces, earning the community’s confidence. This deep engagement made it possible to coordinate mobile visits through team huddles, providing individualized, timely care to people who hadn’t accessed services in years.

“This isn’t numbers driven,” said one team member, “this is people driven.”

Northeast Valley Health Corporation focused on building the business case for investing in social drivers of health. With support from Dignity Health, they developed a closed-loop referral system and integrated tools like the FICA spiritual assessment to better understand patient needs.  

By aligning their efforts with leadership priorities and real-time data, they ensured their approach was grounded in impact, not just ideas.  

“We don’t just screen patients, we want to make sure we’re addressing their needs,” remarked one participant. Their work created a foundation for long-term change and readiness when funding opportunities arise. 

Meanwhile, New Horizon Health Center used the PRAPARE® screening tool to listen more deeply to their patients. Collaborating with UT Health Houston, they uncovered needs that surprised even seasoned clinicians – clothing and medication access topped transportation as major concerns.

As one team member reflected, “This reminded us of the importance of listening and not just assuming. Every patient’s situation is different; everyone has different needs.”  

This data allowed them to pivot their outreach, launching targeted food and clothing drives, and strengthening partnerships to meet identified needs. For them, PRAPARE® wasn’t just a tool; it was a bridge to more meaningful engagement. 

At the culmination of their Design Sprint journey, all four teams gathered in Washington, DC to share their journey: the bold ideas they tested, the real-world challenges they navigated, and the partnerships they strengthened along the way. Despite their unique contexts, a unifying mission came through loud and clear—to harness collaboration, creativity, and compassion to build actionable solutions that address the non-clinical factors shaping health. 

Every design choice circled back to what patients truly need and value. These teams affirmed a powerful truth: when we center people, lead with empathy, and break down silos, we don’t just improve outcomes, we make the best choice the easiest one, and that makes all the difference.

Community Health Centers (CHCs) serve 32.5 million people, or 1 in 10 nationally, providing care in the communities that need it most. This frontline primary care system employs more than 310,000 staff nationwide, spanning physicians, nurses, behavioral health professionals, enabling services providers, and essential administrative and support roles. However, CHCs are facing a major workforce crisis, with significant vacancies and staff turnover that threaten their capacity to meet demand for primary care.  

According to a 2025 NACHC staffing survey (of select positions), approximately 26% of certified nurse midwife positions were vacant, amounting to roughly 300 unfilled roles nationwide. Other core services also reported alarmingly high vacancy rates, including vision care, physicians, behavioral health providers, dental hygienists, and dental assistants, each hovering around 20% or 21%.

In terms of estimated vacancy counts, behavioral health positions had the largest shortfall, with an estimated 5,300 unfilled postions. This was followed by 2,800 vacancies among physician assistants (PAs) and nurse practitioners (NPs), 2,000 open physician roles, and 1,400 pharmacy vacancies.

Staff vacancy is only part of the problem. High turnover across various job categories is compounding the challenge of maintaining care continuity and quality of care. Medical assistants experienced the highest turnover rate at 24%, followed by dental hygenists and assistants at 18%, and both administative staff and registered nurses at 15%. In terms of estimated volume, administrative roles saw the highest churn, with an estimated 22,600 staff departures in a single year. Behavioral health staff followed with 3,700 departures, along with 3,000 PAs and NPs, and 1,700 physicians. 

These figures reflect a deepening strain on the CHC workforce, one that affects both access to care and the ability of CHCs to sustain integrated, team-based models that are foundational to primary care. Without targeted investment in workforce pathways and pipelines, retention strategies, and supportive infrastructure, the CHC model, which has long been a backbone of care for high-need communities, risks being stretched beyond its limits. 

The crisis is not only about staffing levels. As demand grows, care becomes more complex, the envrionment in which staff work is under increasing pressure. Practice transformation, expanded expectations, and the demands of health information technology have introduced new burdens and shift workflows. Even well-intentioned innovations can add administrative burden or disrupt workflows if not supported with the right infrastructure.  

CHCs need sustained investment in streamlined care delivery models, opportunities for professional development and a workplace culture rooted in trust, teamwork, and mission alignment. A bold investment in a resilient and supported workforce is essential to the future of primary care. 

On July 17, NACHC President and CEO Kyu Rhee, MD, MPP, wrote CMS Administrator Dr. Mehmet Oz about the newly created Rural Health Transformation Program, urging the agency to prioritize investment in primary care, especially at Community Health Centers (CHCs).

Read the full letter.