The revelation that healthcare and homelessness solutions both include the need for housing should come as no surprise to anyone. But once housing is provided — and we now have private developers building and renting units for permanent supportive housing programs — the need to bring medical care to people where they live continues. Metro recognizes this need and stresses the importance of medical services, which will be (or are already) provided onsite at Strobel House, its new 90-unit permanent supportive housing project.
Recently, I have been in multiple conversations where providers have discussed the need for a more coordinated approach to support service delivery, whether that be in street outreach, temporary shelter, or permanent supportive housing. What stood out to me is the continuing discussion of the importance of linking people experiencing homelessness and other highly vulnerable populations with healthcare services.
Last month the Commonwealth Fund, a national foundation that aims to promote a high-performing, equitable healthcare system, released an issue brief outlining Federally Qualified Health Centers (FQHCs), also simply known as Community Health Centers (CHCs).
As defined in that issue brief, “FQHCs are community-based outpatient clinics that provide primary medical, dental, behavioral, and other health care services, [which] are funded through a combination of federal funding, Medicaid reimbursements, and other revenues.” Close to 1,400 centers operated in more than 15,000 service sites during 2024.
According to the federal Health Resources and Services Administration (HRSA), FQHCs meet the following criteria.
They:
- Qualify for funding under Section 33 of the Public Health Service Act;
- Qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits;
- Serve an underserved area or population;
- Offer a sliding fee scale;
- Have an ongoing quality assurance program; and
- Have a governing board of directors.
- Provide comprehensive services (either on-site or by arrangement with another provider), including:
- Preventive health services
- Dental services
- Mental health and substance abuse services
- Transportation services necessary for adequate patient care
- Hospital and specialty care;
The Commonwealth Fund’s issue brief entitled, “Community Health Centers’ Progress and Challenges in Meeting Patients’ Essential Primary Care Needs,” outlined findings of a national survey of FQHCs conducted in 2024 and compared them to the last survey completed in 2018. Nearly 740 CHC leaders were engaged to assess whether they feel their clinics achieve the core functions of primary care and what barriers they face.
The highlights of the findings were outlined as follows (copied from the online document):
- Nearly all community health centers offer timely appointments (88 percent) and expanded hours for patients to receive care (93 percent). Rural community health centers are more likely to offer timely appointments (93 percent) than urban community health centers (86 percent).
- Most offer telehealth services in 2024 (96 percent), almost four times as many as in 2018 (24 percent).
- Significantly more community health centers have made substance use disorder treatment (66 percent) and medication-assisted treatment (62%) available to patients in 2024 compared to 2018.
- Community health centers face growing workforce challenges, with over 70 percent reporting primary care physician, nurse, or mental health professional shortages in 2024.
- Most community health centers find it difficult to obtain specialty care appointments for their patients (73 percent), particularly those covered by Medicaid or lacking insurance.
Community Health Centers fill a crucial role by providing low-cost, high-quality primary care. When rural hospitals started closing their doors, CHCs stepped in to fill a gap. Yet their budgets are consistently tight.
One important aspect that other healthcare providers don’t do regularly is that CHCs consistently screen patients for non-medical needs like housing, transportation, food, etc., as outlined in the chart below.
Nationwide, these CHCs serve more than 31 million patients each year. Since they are highly regulated, I was able to pull up a ton of data about the populations they serve through the annually released National Health Data report from HRSA.
Here is a sample of the data that was released in 2023 about people served by CHCs (in my highlights below, I only include data that was complete):
- While patients fell into all age groups, most individuals served were between the ages of 30 and 34.
- In regard to race, 69 percent were white, 21 percent African American, 1 percent Native Hawaiian/Other Pacific Islander, 4.2 percent Asian, 1.7 percent American Indian/Alaska Native, the rest fell under other categories.
- About 38 percent identified as Hispanic or Latino.
- 27 percent of patients were best served by another language than English.
- 95 percent identified as heterosexual.
- 41 percent identified as male, 58.5 percent as female, 0.22 percent as transgender male, and 0.23 as transgender female.
When it comes to income, more than 67 percent live at or below the federal poverty level. Only about 20 percent had private insurance. Of the rest, approximately 18 percent were uninsured, about half were on Medicaid, and roughly 11 percent were on Medicare.
The data also reveals special populations including people experiencing homelessness. Nationwide, a total of 1,447,033 patients experiencing homelessness were served by CHCs.
In Nashville, the largest CHC is Neighborhood Health, which has 12 sites (13 if we include their mobile medical clinic, which visits encampments and other locations five days each week). Neighborhood Health serves roughly 30,000 patients each year providing medical, dental, and behavioral health services. Between 4,000 and 5,000 Neighborhood Health patients are experiencing homelessness, and two of their sites are mainly focused on serving people experiencing homelessness, even though every single Neighborhood Health clinic has patients that fall under the unhoused category.
The following information is from a recent report released by Neighborhood Health about its services to the local homeless population.
As you can see, FQHCs fulfill a critical service not only for the homeless population but also for anyone who is underinsured, lives in poverty, or simply has a tough time accessing healthcare and other services where they live. Locally, our Community Health Centers have fulfilled critical leadership roles in their communities. Read our Q&A with Brian Haile, CEO of Neighborhood Health, to learn more about the impact these clinics have on our vulnerable neighbors.