The University of Chicago.
Milbank Q. 2022 Jun;100(2):504-524. doi: 10.1111/1468-0009.12560. Epub 2022 Apr 12.
Policy Points In the preexpansion period, federally qualified health centers (FQHCs) in Medicaid expansion states were significantly different from those in nonexpansion states. This gap widened as revenues in expansion states continued to grow at a faster rate after the expansion. If Medicaid expansion had occurred nationwide, FQHCs' revenue and capacity could have increased substantially. Over time, Medicaid could play a bigger role as it becomes a more stable funding source to allow for capital investments. Section 330 grants appear to have a larger impact on access to care. Given the varying levels of reliance on Medicaid, investing through federal grants might be more effective and equitable.
The Health Resources and Services Administration's Health Center Program (HCP) plays a critical role as the national ambulatory safety net, delivering services to patients in medically underserved areas, regardless of their ability to pay. As the program has grown, health policy initiatives may have altered access to care for the underserved population. Understanding how federally qualified health centers (FQHCs) have been affected by past policies is important for anticipating the effects of future policies.
By analyzing a national data set from the Uniform Data System, we examined, using two sets of random effects regressions, the potential impact of alternative policy actions affecting FQHCs. Our primary equation models the number of full-time equivalent staff, of patients served, and of visits provided in the subsequent year as a function of Medicaid revenues, Section 330 grants, and other revenues. Our secondary equation is a difference-in-differences analysis that models Medicaid revenues as a function of the states' status of Medicaid expansion.
The expansion of Medicaid in nonexpansion states could have increased Medicaid revenues by 138%, staffing by 25%, and patients' visits by 24% in 2017. Compared to the impact of a "repeal" of Medicaid expansion, the percentage of reductions in staffing would be similar to those predicted by a 50% cut in Medicaid revenues or in Section 330 grants. On a dollar-for-dollar basis, the effects of one dollar of Section 330 grants were more than double that of one dollar of Medicaid revenue.
Both Medicaid eligibility and Section 330 funding support are important to the HCP, and Section 330 grants are particularly closely related to staffing and the provision of services. States' decisions not to participate in or to repeal Medicaid expansion, to reduce Medicaid payment rates, and federal funding cuts all could have a negative impact on FQHCs, resulting in thousands of low-income patients losing access to primary care.
在扩张前时期，参与医疗补助计划的合格联邦健康中心（FQHC）在扩张州与非扩张州之间存在显著差异。在扩张后，扩张州的收入继续以更快的速度增长，这一差距进一步扩大。如果全国范围内实施了医疗补助计划，FQHC 的收入和能力可能会大幅增加。随着时间的推移，医疗补助可能会发挥更大的作用，因为它将成为更稳定的资金来源，允许进行资本投资。第 330 条拨款似乎对获得医疗保健的机会产生了更大的影响。鉴于对医疗补助的依赖程度各不相同，通过联邦赠款进行投资可能会更有效和公平。
卫生资源和服务管理局的健康中心计划（HCP）作为国家门诊安全网发挥着关键作用，为医疗服务不足地区的患者提供服务，无论其支付能力如何。随着该计划的发展，卫生政策倡议可能会改变服务不足人群获得医疗服务的机会。了解合格联邦健康中心（FQHC）过去政策的影响对于预测未来政策的影响非常重要。
通过分析统一数据系统中的全国性数据集，我们使用两组随机效应回归，研究了影响 FQHC 的各种政策行动的潜在影响。我们的主要方程将下一年的全职等效员工数量、服务患者数量和就诊次数建模为医疗补助收入、第 330 条拨款和其他收入的函数。我们的二次方程是一种差异分析，将医疗补助收入建模为各州医疗补助扩张状况的函数。
在 2017 年，非扩张州的医疗补助扩张可能会使医疗补助收入增加 138%，员工人数增加 25%，患者就诊次数增加 24%。与医疗补助扩张“废除”的影响相比，员工人数减少的百分比与医疗补助收入减少 50%或第 330 条拨款减少的预测百分比相似。在一对一的基础上，一美元的第 330 条拨款的效果是一美元医疗补助收入的两倍多。
医疗补助资格和第 330 条资金支持对 HCP 都很重要，第 330 条拨款与员工人数和服务提供特别密切相关。各州不参与或废除医疗补助扩张、降低医疗补助支付率以及联邦资金削减的决定都可能对 FQHC 产生负面影响，导致数千名低收入患者失去获得初级保健的机会。
