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Ryan White and ACA: Becoming a Health Center, Tips and Resources

Ryan White and ACA: Becoming a Health Center, Tips and Resources

December 9, 2013
TARGET Center
Health Center Impact Data 2012

Door number 1, 2, or 3? On television, you'd better guess right or you'll go home with a box of soap instead of a shiny new car.

That classic game show dilemma provides an awkward and awfully imprecise analogy for what Ryan White agencies face when deciding how to restructure around health care reform. For one, there are far more than three choices, and many offer a prize, so to speak, to surviving and thriving.

Our ongoing ACA Restructuring blogs are looking at what Ryan White agencies are doing to adjust to health care reform, like the efforts of Catawba Care in South Carolina, which is pursuing Health Center status after deliberation by its board and a decision to proceed. This blog takes a brief look at the Health Center program and summarizes some of the resources available to help agencies interested in securing Health Center designation.

Definitions, History and Expansion

First, a bit of background. The definition of Health Center is rich, but put in its simplest terms: Health Centers deliver primary medical care to underserved individuals. There are more than 1,200 in operation at 9,000 sites around the nation, serving over 21 million people. They fall within more than one category: FQHCs, Look-Alikes (that do much of what an FQHC does but without HRSA 330 funding), and tribal programs.

The Health Center program started in the mid 1960s as a War on Poverty/Great Society program to bring new access to health care for impoverished and minority communities. The program has experienced gradual growth over its more than 45-year history, with several bursts, from one in the early 2000s under President George W. Bush and a more recent expansion as part of Affordable Care Act and Health Center work—and the National HIV/AIDS Strategy—to provide new care options for the expanding population of insured individuals. Indeed, the Ryan White and Health Center worlds are increasingly coming together, most recently under the HRSA initiative to improve the HIV Care Continuum by linking more people into HIV care and maximizing viral suppression. Called Increasing Access to HIV Care and Treatment, the $15 million project includes 275 Ryan White HIV clinical sites, 174 of which also are dually funded Health Centers.

Why Do It?

A significant number of Ryan White Part C community-based grantees have secured some type of Health Center designation. Approximately 12% of Health Centers are Part C community-based grantees. Some had that designation before securing Ryan White funding while others achieved Health Center status later. More are going down this path today, including Catawba Care, which was one of seven Ryan White Part C grantees that received planning grants in 2011 to explore Health Center status. About eight more AIDS service organizations received planning grants in 2013.

Becoming a Health Center requires effort, as we outline below. So, why did these agencies commit to it and why are others thinking about it? HRSA outlines the benefits, such as enhanced Medicaid reimbursement rates and medical malpractice coverage under the Federal Tort Claims Act. Catawba is perhaps typical of Ryan White agencies contemplating this move to what they call Transition to Community Health in the midst of changes around ACA. Their motivations?

  • Potential changes in Ryan White funding and a need to diversify agency funding and services
  • The national move to integrate HIV/AIDS care within broader health-care systems, including Health Centers that reach lower income minority populations disproportionately affected by HIV/AIDS
  • Desire to bring a comprehensive model of care to a broader community facing gaps in care

Getting Started

Becoming a Health Center is a process that should start after assessing the need for services in the target area. A key step is to determine what Health Centers are already in operation in the service area. See HRSA Health Center data, State Data), which offers a map of service areas, demographics, cost data, and more. 

If a need is evident, subsequent steps include, for example, identification of potential partners and expertise. Time and resources, of course, are essential. (See the sidebar for more detailed insights and technical guidance on pursuing Health Center status.) Agencies that are planning to provide primary medical care, or already are doing so, are probably better positioned to pursue Health Center designation. In contrast, agencies without a history delivering primary care could start by conducting a formal Health Center needs assessment (which can be supported by a Health Center planning grant). Another option is to establish a formal referral agreement with an existing Health Center in the service area.

Regardless of where your agency stands, health care reform requires change. Tell us what your agency is doing?

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