Every year, the Health Resources and Services Administration (HRSA) recognizes Community Health Centers (CHCs) that deliver measurable excellence in care. The most recent quality badge data show a consistent national pattern of CHCs achieving strong clinical outcomes despite limited resources and rising patient complexity. These CHCs serve patients with some of the highest medical and social needs in the country, and yet continue to outperform national averages in chronic disease management and preventive care. This performance is not only symbolic, but also evidence that CHCs, the backbone of the nation’s primary care infrastructure, can deliver value and accountability at scale.
Across the country, CHCs serve more than 34 million people annually and manage care for as many as 52 million. Nearly one in five CHC patients have no health insurance, yet these CHCs deliver comprehensive primary and preventive care regardless of ability to pay. They achieve this reach while operating on some of the narrowest margins in American health care. In 2024, CHC costs exceeded revenue for the first time, with average operating margins falling below negative 2 percent. With looming Medicaid cuts, many CHCs are confronting the real possibility of site closures, staff reductions, and service cutbacks. These financial pressures threaten the gains reflected in HRSA’s quality data.
National and State CHC Performance on Clinical Quality Measures
Quality can be measured in many ways, from patient experience to clinical outcomes. This blog focuses on HRSA Quality Badges, which measure CHCs against standardized benchmarks for clinical performance, high-value care, and health IT use, highlighting CHCs that achieve exceptional outcomes despite challenging patient populations and resource constraints.
Table 1 illustrates how CHCs across the country sustain high performance while serving as a major source of care for uninsured in many states. The table reflects the top 30% of CHCs nationwide, highlighting those that earned HRSA Gold (top 10%), Silver (11%-20%), and Bronze (21%-30%) Badges for clinical excellence. In Nebraska, Puerto Rico, Rhode Island, and South Dakota, at least half of CHCs in these states earned HRSA Quality Badges for clinical excellence while caring for at least one in four uninsured residents.
Some states, however, have relatively few recognized CHCs. This variation reflects differences in infrastructure, funding, and capacity to meet national benchmarks, highlighting the importance of targeted investment to ensure all states can support high-performing primary care.
Table 2 highlights additional areas of achievement, including the adoption of health information technology and other value-based metrics. Every state has at least one CHC recognized for excellence, underscoring the national scale of achievement across diverse care settings.
Why Clinical Quality Measures Matters to States
These results should matter deeply to every state. CHCs serve a large share of state people who are insured through Medicaid, and when CHCs perform well, states benefit through better outcomes and lower costs. Strong primary care reduces preventable hospitalizations, emergency department utilization, and downstream costs in specialty and reduces avoidable deaths.
For states facing fiscal pressure, investing in CHCs is a proven strategy to strengthen the health system and protect access. States that maintain strong CHC networks can see measurable gains in maternal health, behavioral health access, and chronic disease control that directly affect state budgets.
CHCs are a Model of Innovation and Efficiency in Action
Decades of research have confirmed these patterns. CHCs consistently deliver care at lower cost than comparable settings while improving outcomes. Their leadership in programs such as Food for Health (which includes Food Is Medicine programs), AI-assisted technologies, and community health worker integration show how innovation and efficiency can thrive even in resource-constrained environments.
Aligning Funding with Evidence
Sustaining this level of performance requires a financing strategy that aligns with the evidence. As Medicaid revenue declines and discretionary support remains uncertain, the risk is not theoretical. Each badge and each metric underscore the same conclusion: reducing CHC support does not reduce costs. It simply shifts costs to emergency departments, hospitals, and systems far less equipped to manage chronic care effectively.
Quality is not an exception in CHCs. It is the standard expectation. Ensuring that funding aligns with proven performance is essential for protecting access, improving outcomes, and containing costs at the state and national level.
Table 1. Top CHCs and Uninsured Coverage by State, 2024
| State | Number of CHCs | Health Center Quality Leader – Gold | Health Center Quality Leader – Silver | Health Center Quality Leader – Bronze | Total Quality Badges | % of CHCs Earning Top 30% Badges | % state Uninsured served by CHCs |
| AK | 29 | 1 | 0 | 3 | 4 | 14% | 24% |
| AL | 19 | 4 | 0 | 1 | 5 | 26% | 21% |
| AR | 12 | 2 | 1 | 0 | 3 | 25% | 22% |
| AZ | 24 | 0 | 3 | 3 | 6 | 25% | 19% |
| CA | 214 | 17 | 19 | 24 | 60 | 28% | 26% |
| CO | 20 | 1 | 2 | 3 | 6 | 30% | 35% |
| CT | 17 | 1 | 4 | 3 | 8 | 47% | 33% |
| DC | 8 | 0 | 2 | 0 | 2 | 25% | 96% |
| DE | 3 | 0 | 0 | 0 | 0 | 0% | 19% |
| FL | 54 | 6 | 5 | 3 | 14 | 26% | 19% |
| GA | 36 | 2 | 6 | 6 | 14 | 39% | 15% |
| HI | 14 | 1 | 0 | 1 | 2 | 14% | 30% |
| IA | 14 | 3 | 2 | 0 | 5 | 36% | 30% |
| ID | 14 | 2 | 1 | 0 | 3 | 21% | 28% |
| IL | 51 | 4 | 3 | 5 | 12 | 24% | 33% |
| IN | 41 | 2 | 4 | 3 | 9 | 22% | 22% |
| KS | 21 | 3 | 3 | 0 | 6 | 29% | 35% |
| KY | 30 | 8 | 5 | 3 | 16 | 53% | 29% |
| LA | 41 | 5 | 5 | 3 | 13 | 32% | 23% |
| MA | 37 | 4 | 4 | 4 | 12 | 32% | 66% |
| MD | 16 | 1 | 2 | 3 | 6 | 38% | 20% |
| ME | 19 | 3 | 2 | 1 | 6 | 32% | 24% |
| MI | 41 | 3 | 7 | 2 | 12 | 29% | 18% |
| MN | 17 | 1 | 1 | 1 | 3 | 18% | 18% |
| MO | 29 | 2 | 2 | 2 | 6 | 21% | 24% |
| MS | 21 | 4 | 1 | 0 | 5 | 24% | 32% |
| MT | 14 | 0 | 3 | 0 | 3 | 21% | 22% |
| NC | 43 | 3 | 6 | 2 | 11 | 26% | 24% |
| ND | 4 | 0 | 0 | 1 | 1 | 25% | 16% |
| NE | 7 | 3 | 0 | 1 | 4 | 57% | 29% |
| NH | 10 | 0 | 2 | 0 | 2 | 20% | 23% |
| NJ | 24 | 2 | 2 | 0 | 4 | 17% | 23% |
| NM | 20 | 0 | 2 | 0 | 2 | 10% | 35% |
| NV | 8 | 0 | 0 | 0 | 0 | 0% | 10% |
| NY | 72 | 8 | 4 | 5 | 17 | 24% | 32% |
| OH | 60 | 6 | 8 | 8 | 22 | 37% | 17% |
| OK | 21 | 0 | 2 | 1 | 3 | 14% | 13% |
| OR | 32 | 3 | 0 | 1 | 4 | 13% | 18% |
| PA | 51 | 3 | 0 | 3 | 6 | 12% | 23% |
| PR | 21 | 7 | 4 | 0 | 11 | 52% | 26% |
| RI | 8 | 2 | 3 | 0 | 5 | 63% | 44% |
| SC | 25 | 6 | 3 | 3 | 12 | 48% | 23% |
| SD | 4 | 0 | 1 | 1 | 2 | 50% | 27% |
| TN | 30 | 3 | 4 | 2 | 9 | 30% | 21% |
| TX | 75 | 8 | 8 | 10 | 26 | 35% | 12% |
| UT | 12 | 0 | 1 | 0 | 1 | 8% | 22% |
| VA | 27 | 3 | 3 | 3 | 9 | 33% | 15% |
| VT | 11 | 0 | 3 | 0 | 3 | 27% | 86% |
| WA | 27 | 1 | 2 | 1 | 4 | 15% | 34% |
| WI | 18 | 0 | 2 | 0 | 2 | 11% | 16% |
| WV | 30 | 5 | 4 | 2 | 11 | 37% | 55% |
| WY | 5 | 0 | 0 | 0 | 0 | 0% | 11% |
| US | 1,501 | 143 | 151 | 118 | 412 | 8% | 22% |
Note: HRSA awards badges based on adjusted quartile rankings using the latest CHC clinical data. These badges recognize the top 30%, with the Gold Badge representing the top 10%. Excludes US Territories except Puerto Rico.
Table 2. CHC Excellence Across Value, Access, Care Delivery, and HIT in Every State, 2024
| State | % State Medicaid enrollees served by CHCs | High-Value | Improving Health Care Access | National Quality Leader – Behavioral Health | National Quality Leader – Cancer Screening | National Quality Leader – Diabetes Health | National Quality Leader – Heart Health | Preventive Health | Advancing HIT |
| AK | 29% | 0 | 4 | 0 | 2 | 0 | 1 | 0 | 14 |
| AL | 12% | 4 | 3 | 1 | 1 | 7 | 4 | 4 | 15 |
| AR | 21% | 0 | 2 | 2 | 0 | 2 | 2 | 0 | 9 |
| AZ | 23% | 1 | 3 | 1 | 0 | 2 | 1 | 2 | 13 |
| CA | 60% | 23 | 76 | 23 | 14 | 23 | 18 | 22 | 110 |
| CO | 27% | 0 | 3 | 3 | 0 | 3 | 2 | 1 | 9 |
| CT | 39% | 3 | 4 | 2 | 0 | 3 | 4 | 2 | 13 |
| DC | 92% | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 6 |
| DE | 8% | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 3 |
| FL | 15% | 7 | 10 | 12 | 3 | 14 | 9 | 9 | 33 |
| GA | 9% | 3 | 10 | 9 | 2 | 6 | 7 | 5 | 18 |
| HI | 30% | 1 | 2 | 0 | 0 | 1 | 2 | 1 | 10 |
| IA | 24% | 0 | 3 | 1 | 0 | 0 | 4 | 0 | 7 |
| ID | 22% | 6 | 6 | 1 | 0 | 1 | 2 | 1 | 11 |
| IL | 36% | 7 | 6 | 6 | 3 | 11 | 11 | 9 | 30 |
| IN | 34% | 5 | 13 | 1 | 0 | 4 | 6 | 1 | 31 |
| KS | 18% | 1 | 4 | 2 | 1 | 3 | 6 | 2 | 14 |
| KY | 40% | 0 | 6 | 6 | 0 | 7 | 7 | 2 | 23 |
| LA | 34% | 5 | 6 | 6 | 3 | 6 | 10 | 7 | 24 |
| MA | 26% | 3 | 11 | 1 | 4 | 1 | 6 | 3 | 27 |
| MD | 14% | 2 | 7 | 1 | 1 | 1 | 2 | 1 | 12 |
| ME | 29% | 1 | 4 | 2 | 2 | 1 | 2 | 1 | 8 |
| MI | 18% | 3 | 5 | 3 | 0 | 3 | 9 | 1 | 31 |
| MN | 8% | 2 | 5 | 0 | 0 | 1 | 3 | 1 | 12 |
| MO | 33% | 2 | 8 | 8 | 0 | 5 | 3 | 2 | 24 |
| MS | 16% | 5 | 6 | 5 | 2 | 8 | 9 | 1 | 16 |
| MT | 19% | 2 | 2 | 0 | 1 | 0 | 0 | 0 | 10 |
| NC | 12% | 4 | 11 | 6 | 1 | 2 | 7 | 2 | 24 |
| ND | 9% | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 3 |
| NE | 14% | 1 | 2 | 2 | 0 | 2 | 4 | 3 | 4 |
| NH | 10% | 0 | 2 | 1 | 1 | 0 | 0 | 0 | 5 |
| NJ | 18% | 4 | 8 | 6 | 3 | 6 | 2 | 5 | 12 |
| NM | 31% | 2 | 1 | 1 | 0 | 3 | 1 | 1 | 6 |
| NV | 8% | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
| NY | 31% | 8 | 12 | 9 | 4 | 5 | 7 | 5 | 46 |
| OH | 25% | 6 | 12 | 8 | 1 | 12 | 10 | 5 | 48 |
| OK | 17% | 4 | 4 | 2 | 0 | 5 | 0 | 1 | 11 |
| OR | 37% | 2 | 4 | 2 | 0 | 4 | 0 | 1 | 21 |
| PA | 19% | 4 | 9 | 6 | 2 | 1 | 8 | 2 | 23 |
| PR | 32% | 2 | 2 | 9 | 3 | 4 | 6 | 5 | 13 |
| RI | 49% | 2 | 3 | 2 | 0 | 1 | 0 | 0 | 7 |
| SC | 12% | 1 | 5 | 3 | 1 | 4 | 9 | 2 | 12 |
| SD | 18% | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 3 |
| TN | 10% | 5 | 9 | 7 | 2 | 9 | 11 | 4 | 19 |
| TX | 10% | 11 | 13 | 12 | 4 | 13 | 7 | 7 | 39 |
| UT | 5% | 1 | 3 | 0 | 0 | 1 | 1 | 0 | 5 |
| VA | 9% | 2 | 7 | 2 | 1 | 6 | 9 | 1 | 18 |
| VT | 51% | 3 | 3 | 1 | 2 | 0 | 3 | 0 | 10 |
| WA | 51% | 5 | 6 | 1 | 0 | 1 | 1 | 0 | 19 |
| WI | 18% | 4 | 5 | 0 | 0 | 1 | 1 | 0 | 11 |
| WV | 62% | 2 | 7 | 5 | 0 | 5 | 9 | 1 | 16 |
| WY | 7% | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 3 |
| US | 26% | 161 | 338 | 181 | 66 | 200 | 228 | 124 | 911 |
Note: National Quality Leader Badges recognize CHCs meeting or exceeding national benchmarks on select indicators. The High-Value Care badge reflects achievement in both quality and cost benchmarks. The Advancing HIT for Quality badge recognizes use of telehealth as well as the collection and exchange of patient data. For full badge description visit HRSA’s Community Health Quality Recognition Overview: https://bphc.hrsa.gov/initiatives/advancing-health-center-excellence/community-health-quality-recognition-chqr-overview Excludes US Territories except Puerto Rico.