​Maria-Elena Young is a doctoral candidate in the UCLA Fielding School of Public Health's Department of Community Health Sciences and a co-author of a new study on the role of community health centers (CHC) in a post-ACA landscape. In this brief interview, Young discusses who uses community health centers, the state of CHC funding, and why staffing is difficult.

Q: Who is seeking care at community health centers in the ACA era? Did the centers lose patients after the law passed, as some experts predicted?

​We found that community health centers (CHCs) serve a very diverse mix of patients ― both uninsured and insured. Our study focused on CHCs in immigrant communities and we certainly found that significant portions of the uninsured are ineligible for insurance due to their legal status.

However, we also found that CHCs are serving many other populations who are still uninsured due to a wide range of barriers to insurance. In Texas and Georgia, there are still many adults who cannot get Medicaid. Across all four states, vulnerable populations, such as the homeless or migrant farm workers, continue to seek care at CHCs. Finally, CHCs are providing care to individuals who have insurance through the insurance exchanges, but just can't afford the co-pays or deductibles. But thanks to the ACA, the majority of patients now have insurance.

Contrary to what many anticipated, CHC directors reported that very few of their newly insured, long-term patients left for different providers. In fact, a common characteristic across their diverse patient populations was that most people were long-time patients of the CHCs and, regardless of their insurance status, continued to seek care at these organizations. Given the choice between a community health center and a new provider, many people stuck with what they knew.

Q: Federal funding has been an important part of the equation but may be reduced in the future. How will CHCs replace this source of funding and what happens if they don't?

​One of the major findings of this research was the importance ― and future uncertainty ― of the federal core funding for CHCs. All of the CHC directors that we spoke with emphasized that their mission was to serve everyone who needed care ― particularly the remaining uninsured. Federal funding makes it possible for them to achieve that mission. All are working to bring in more diverse revenue ― either from patients insured through Medicaid or the Marketplace or private grants. This will help, but likely could never make up the difference if federal funding were cut.

Several directors told us that a cut to or loss of their federal funding would lead to as much as a third or a half reduction in the number of patients they can serve. Some said their organization could not continue without it. The loss of federal funding will jeopardize the ability of CHCs to meet their mission.

Q: Staffing is a chronic challenge at CHCs. Where are the needs most acute?

​The majority of the CHC directors we spoke with struggled to recruit and fund both clinical and non-clinical positions. On the clinical side, CHCs have a hard time offering competitive salaries. On the administrative side, it is difficult to fund the care coordination and administrative staff that perform crucial, but non-reimbursable services. An additional challenge ― but also a key priority ― was to recruit staff who have a commitment to working with the underserved and uninsured populations.

The challenges in achieving the right staffing levels play out differently in each area. The needs are most certainly most acute in regions with high provider salaries (such as large metro areas) or provider shortages (such as rural areas with smaller workforces). But the challenges are also felt by CHCs that are smaller or have less flexibility in their funding, as they have less capacity to make adjustments to meet staffing needs.