Federal Requirements for Medicaid FQHC

FQHCs are federally qualified health centers.

Being uninsured, underinsured, and/or isolated makes people medically vulnerable. The Health Resources and Services Administration (HRSA) was created as an agency within the U.S. Department of Health and Human Services to help improve access for the medically vulnerable. One of the main ways that this has been accomplished is through federally qualified health centers (FQHCs), which are non-profit "safety net" healthcare providers that offer Medicaid Managed Care to medically underserved populations.

Board of Directors

FQHCs are created by grants that are awarded under the guidance of Title 42 USC § 254b (Health centers). All federal grantees wishing to set up a FQHC must demonstrate they are a non-profit organization with a board of directors with more than half of its members being active, registered clients of the FQHC. The make up of the board of directors must also be representative of the target populations the FQHC serves.

Location

FQHCs are required to be located within designated Medically Underserved Areas (MUAs) and/or to serve designated Medically Underserved Populations (MUPs), both of which are Health Professionals Shortage Areas (HPSAs) defined under federal law based on an Index of Medical Underservice (IMU) rating from zero to 100, with zero being completely underserved.

MUAs are areas that have an IMU rating of less than 63.0, using the ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level and a percentage of the population age 65 or over.

MUPs are low-income or Medicaid-eligible populations that have an IMU rating of less than 63.0, using the ratio of primary medical care physicians per 1,000 population that specifically serve the target population, infant mortality rate of the target population, percentage of the target population with incomes below the poverty level, and percentage of the target population age 65 or over.

Required Services

FQHCs are required to provide certain primary health services that are appropriately furnished by physicians, physician assistants, nurse practitioners and nurse midwives. These requirements are necessary to maintain their classification and receive federal grants. The required services, outlined at Title 42 USC § 254b(b)(1)(A), include: family medicine, internal medicine, pediatrics, obstetrics, and/or gynecology; diagnostic laboratory and radiologic services; prenatal and perinatal services; appropriate cancer screening; well-child services; immunizations against vaccine-preventable diseases; screenings for elevated blood lead levels, communicable diseases and cholesterol; pediatric eye, ear and dental screenings to determine the need for vision and hearing correction and dental care; voluntary family planning services; preventive dental services; emergency medical services; and appropriate pharmaceutical services for particular centers.

Also, FQHCs must provide referrals to providers of medical services and other health-related services; patient case management services and other governmental assistance eligibility services; outreach and transportation services; appropriate English as a Second Language services; and general population health education services.

Additional Services

HRSA highly recommends that FQHCs provide any combination of the additional health-related services listed at 42 USC § 254b(b)(2). These include: behavioral and mental health and substance abuse services; recuperative care services; environmental health services; and appropriate occupation-related health services for migratory and seasonal agricultural workers.

References

• Cornell University Law School: Title 42 USC § 254b (Health centers)
• U.S. Health Resources and Services Administration: The Health Center Program--Policy Information Notices & Program Assistance Letters
• U.S. Health Resources and Services Administration: Shortage Designation--Medically Underserved Areas & Populations