United States: Community Health Center Fund: A Minibus Rider

Over the past month, we provided additional details on the structure, funding, and evaluation of the Maternal, Infant, Early Childhood, Home Visiting (MIECHV) program and Medicare Therapy Caps. In this post we will go into detail on the structure, funding, and outlook of the "primary care cliff," and specifically the three programs relating to community health centers. This is part of an ongoing series we are doing on the potential riders of a health care minibus. The "minibus" refers to a handful of policy provisions tied together in one piece of legislation. This minibus will carry a number of provisions into law, although the number of riders onboard the minibus, and when the minibus leaves the station, remains to be seen.

Future posts will review additional details of other potential riders on the minibus.


Funding for community health centers that is up for extension includes: community health center funding provided through section 330 of the Public Health Service Act, the National Health Service Corps (NHSC), and the Teaching Health Center Graduate Medical Education (THCGME) program. Funding for each of these programs was most recently extended through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). These programs need to be reauthorized by September 30, 2017, in order to continue.

Community Health Centers

Funding for community health centers has been bipartisan for decades. Congress enacted the health center program in the 1960s to address a lack of primary health care services and a growing number of medically underserved areas. In 1975, the community health center program was authorized under section 330 of the Public Health Service Act, and has been reauthorized and expanded to focus on underserved communities and vulnerable populations. In 1996, the Health Center Consolidation Act brought together various health center programs under the same umbrella to support the continued development of community-based health centers. In 2002, the Health Care Safety Net Amendments reauthorized the health center program, requiring health centers to participate in the Children's Health Insurance Program, in addition to authorizing various grant programs. In 2010, the Affordable Care Act (ACA) established the Community Health Center Fund (CHCF), which provides a mandatory funding stream for community health centers.

Funding for community health centers through the Public Health Service Act is designed to be used for various health care activities, including expanding and improving the services provided at existing health centers, as well as building new health centers and various grant programs. Additionally, the fund can be used to address public health emergencies. In 2015, according to the National Association of Community Health Centers, federally funded health centers served over 24 million patients while employing over 180,000 individuals.

National Health Service Corps

The NHSC is a program designed to place clinicians in health professional shortage areas by making loan repayment and scholarships available to clinicians in exchange for at least two years of their service. The program was created in response to a primary care shortage in the 1950s and 1960s. The Emergency Health Personnel Act Amendments established the NHSC Scholarship Program in 1972, and within six months of its enactment placed nearly 180 clinicians in over 100 communities. Currently, an estimated 10,400 NHSC clinicians provide care to over 11 million people in rural and urban health shortage areas. The ACA permanently reauthorized the NHSC and provided mandatory funding through fiscal year 2015. Prior to the ACA, the NHSC relied solely on annual discretionary appropriations that were established during its inception in the early 1970s. The NHSC was last authorized by MACRA through September 30, 2017.

As of FY2015, according to the Congressional Research Service, behavioral and mental health clinicians make up the majority of the NHSC field staff, followed by allopathic/osteopathic physicians, nurse practitioners, and dentists. Among the changes in the ACA, NHSC clinicians can count time spent teaching at teaching health centers towards their NHSC service commitments.

The Teaching Health Center Graduate Medical Education Program

The THCGME program was established by the ACA in 2010 and aims to increase the number of primary care residents and dentists trained in community-based settings, address the primary care workforce shortage (specifically in rural and underserved areas), and provide health care services in underserved communities. Through the THCGME program, primary care physician interns and residents are trained in a community-based setting, instead of the traditional hospital-based setting. The THCGME program trains residents in a number of specialties, including family medicine, pediatrics, psychiatry, obstetrics, gynecology, dentistry, pediatrics, internal medicine, and geriatrics.

The program has grown from 11 programs in its first year of funding to 59 programs in this current academic year. During the last academic year (2016-2017), the THCGME program supported the training of over 700 residents across 24 states. The program was extended through MACRA. However, per resident payment was reduced from $150,000 to $95,000 for teaching health centers, placing increased financial strain on the programs. There is an ongoing evaluation of the THCGME program.

Funding Cliff

The Community Health Center Funds have been awarded annually since 2011 to all 50 states and the District of Columbia, as well as the U.S. territories. For FY2016 and FY2017, MACRA provided $3.6 billion for health centers, $310 million for the NHSC, and $60 million for teaching health centers. These programs need to be reauthorized by September 30, 2017.


In President Trump's FY2018 budget, the Administration calls for continued funding of CHCs, the NHSC, and THCGME. CHC's would receive an $89 million increase, NHSC funding would see an increase of $21 million, and THCGME would be increased by $4 million (based off the recently passed FY2017 budget). Funding for CHC's was also included in a number of the proposed repeal bills, suggesting that there is support for these programs to continue on both sides of the aisle.

Congress will have to produce a package that extends these programs by September 30th. However, there are a number of competing issues (e.g., the debt limit) that Congress must address upon returning from recess, which could extend the health care minibus discussions beyond this deadline.

As for the minibus, it's not really a question of policy – but of politics. Community health center funding, and other riders on the minibus, will need 60 votes to pass. So Republicans and Democrats will need to work together and comprise to move community health center and other minibus riders along. Following the health care repeal debate, it's still unclear whether there is an appetite for bipartisan collaboration.

We will listen for signs of progress in early September.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Rodney L. Whitlock
Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions