Community health centers are a linchpin of New York’s health care safety net, providing comprehensive primary care, behavioral health, and dental and vision services to 2.3 million patients–of whom more than half are Medicaid enrollees.

This report and fact sheet describe the critical role of community health centers in supporting the state’s health equity goals and examines the New York State Medicaid prospective payment system (PPS) as a foundation for ensuring access to equitable and comprehensive primary care.

WHY THIS MATTERS

Community health centers are essential partners in promoting health equity by serving underresourced communities and providing health care for populations who may otherwise lack access to health care. Since community health centers rely heavily on Medicaid revenue, the Medicaid policy is an important lever for strengthening the reach and impact of community health centers.

WHAT WE FOUND

• With a robust network of over 800 service delivery sites in 52 of the state’s 62 counties, community health centers have a strong and thriving presence in New York.
• Compared with New York’s population, community health centers disproportionately serve people who may face barriers to accessing health care and likely experience health disparities, including people experiencing poverty and uninsurance, people from racial and ethnic minority groups, and those with limited English proficiency.
• Community health centers have been integral to many of New York’s signature initiatives to transform health care delivery and have expanded their capacity to effectively meet complex patient needs. They are also an important source of employment and health workforce training opportunities in the communities they serve.
• New York State Medicaid PPS rate methodology includes ceilings on operating costs to cap community health center payments. An analysis of cost reports from over half of community health centers suggests that costs exceed the ceiling by at least 44 percent for most patient visits.
• Almost a third of Medicaid payments to community health centers are delayed through the supplemental payment program, which pays community health centers the difference between the average per-visit managed care rates and PPS rates for primary care services.

The discrepancy between Medicaid PPS ceilings for community health centers and actual costs per visit presents a barrier to further enhancing and expanding access to integrated and whole-person care that is crucial to effectively serve patients experiencing health inequities. Based on these findings, we recommend several strategies New York can consider to strengthen and expand community health centers' capacity and support a more equitable health care system, including the following:

• updating the PPS rates to reflect the cost of care more accurately
• developing an alternative payment model specific to advanced primary care
• requiring managed care plans to make full PPS payments for all services delivered by community health centers

HOW WE DID IT

The data for this study come from a combination of quantitative and qualitative sources. We reviewed publicly available policy documentation and analyzed data from the New York Health Center Program Uniform Data System and community health center cost reports. We also conducted interviews and focus groups with community health center leaders and other stakeholders.