NACHC Statement Regarding the Supreme Court Ruling on the Public Charge Rule
January 28, 2020
Community Health Center Leaders to Attend State of the Union Address
February 4, 2020
NACHC Statement Regarding the Block Grant Guidance Issued by the Centers for Medicare and Medicaid Services

Today, the Centers for Medicare and Medicaid Services released its new guidance (“Healthy Adult Opportunity,” SMD 20-001) to allow states to make unprecedented changes to their Medicaid programs through waivers to implement block grants and per capita caps. The National Association of Community Health Centers (NACHC) issued the following statement:

Community Health Centers are the nation’s largest network of safety net primary care providers, serving 29 million patients and one in five Medicaid beneficiaries. Should states choose to pursue Medicaid block grants – specifically designed to cap Medicaid spending – we have serious concerns about the detrimental impact on the patients we serve and other vulnerable populations.

Of particular concern is CMS’ indication that it will consider allowing states to waive longstanding requirements regarding mandatory FQHC Medicaid services and payment.  This approach creates the ability for states to significantly alter the way health centers are funded and deliver care. At a time when health centers are among the most cost-effective care providers in the nation, this proposal could remove a core funding pillar that protects health centers’ ability to serve America’s most vulnerable.

There is considerable evidence that transitioning a state’s Medicaid program into a block grant leads to funding cuts, reduced benefits, and ultimately less healthy outcomes for patients. A recent study from the George Washington University noted a block grant proposal would have a significant impact on health centers – this would translate into approximately 5 million fewer patients served in underserved rural and urban areas in 2024.

Finally, the historic alignment between health centers and Medicaid has improved the health care delivery system and generated savings for taxpayers. Health centers’ role in creating a strong health safety net enables our patients to access affordable primary care when and where they need it, preventing more costly treatments in hospitals and elsewhere. Health centers save, on average, $2,371 (or 24 percent) per Medicaid patient.

Health centers have enjoyed bipartisan support for five decades precisely because of their effectiveness at ensuring access to primary health care across the nation. This guidance threatens to reverse these gains. That is why we call on the Administration and any states considering the options set forth in this new guidance to weigh these impacts before taking action.


Established in 1971, the National Association of Community Health Centers (NACHC) serves as the national voice for America’s Health Centers and as an advocate for health care access for the medically underserved and uninsured.

Amy Simmons Farber