As Congress debates major changes to Medicaid, millions of Americans are at risk of losing coverage. The bill currently being considered in the House includes changes to Medicaid that NACHC estimates would lead to major losses in health coverage for Community Health Center (CHC) patients. These policies will affect patients’ health and the financial health of CHCs.
Estimating the Number of CHC Patients Insured Through Medicaid Who Could Lose Coverage
In its analysis of the House bill, the Congressional Budget Office projects that by 2034, 10.3 million people will lose Medicaid coverage and 7.6 million will become uninsured. Of those figures, NACHC estimates that roughly 2 million CHC patients will lose coverage and CHCs will see 1.7 million more people without insurance.
For CHC patients, losing Medicaid coverage means losing access to essential healthcare services, like primary and preventive care. It means a lapse in managing chronic diseases, skipping life-saving screenings, and forgoing other primary care services. It also raises patients’ risk of acquiring medical debt.
Community Health Centers Will See More Uninsured Patients
For CHCs, this growing coverage gap will mean they see a larger share of patients without insurance, while they are already straining to meet rising demand.
By law and by mission, CHCs serve all patients who walk through their doors, regardless of income or insurance status. A decade ago, CHCs served 15% of the nation’s uninsured. That number now exceeds 22% (Figure 1). At the same time that CHCs are experiencing increases in uninsured patients, they are operating under stagnant federal funding levels.
Medicaid Cuts Will Harm Community Health Center Operations and Impact
CHCs rely heavily on two major funding sources: Medicaid, which provides about 42% of CHC revenue, and federal Section 330 grants, which account for approximately 12% of CHC funding.
Reductions in federal Medicaid spending could lead directly to reduced services, staff layoffs, and, in some cases, clinic closures. Currently, the majority of CHCs face negative financial margins, and one in four CHCs may close or reduce services over the next two years without increased funding.
CHC federal grant funding remains uncertain beyond September 2025. Without long-term reauthorization, CHCs would face financial instability, forcing them to halt expansion projects, scale back services, freeze hiring, or cut essential patient services.
CHCs want to partner with lawmakers as they deliberate changes to the healthcare system. CHCs’ unique role and proven track record of delivering high-quality care and meaningful savings is a model for the broader system. Greater investment in primary care leads to better outcomes, higher patient satisfaction, and reduced costs. Policymakers should re-focus the healthcare system by prioritizing greater investment in primary care and considering how policy changes impact CHCs and their patients.
View NACHC Medicaid resources: Find resources to take action and share with your networks why Medicaid matters to CHC patients, CHCs, and the community.