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.