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Research Objective: The Community Health Center Fund (CHCF) was created by the Affordable Care Act in 2011 to increase access to federally qualified health centers (FQHCs), and now comprises the majority of federal Section 330 funds that support FQHCs. The CHCF, however, has faced numerous expirations and short‐term extensions since 2015, which could pose challenges to long‐term planning, especially for FQHCs that rely more on federal funds. To examine the potential implications of changes or lapses in federal funding, we identified FQHCs that likely receive a larger share of revenue from federal funds and compared their local area traits with other FQHCs. Study Design: We used publicly available data for 2010–2018 from the Uniform Data System, which contains information on FQHC traits, patient volume, and non‐patient revenue. Because total and patient revenue were unavailable, we classified FQHCs as receiving a high share of total revenue from Section 330 funding if >75% of their non‐patient revenue was from Section 330 funding and > 25% of their patients were uninsured (as a proxy for patient revenue). We assessed the association between annual changes in Section 330 funding and FQHC patient volume for FQHCs meeting this classification vs. not, using multivariate linear regression with FQHC‐level random effects. We then compared FQHCs with vs. without a high share of revenue from Section 330 funding in 2018 using multivariate logistic regression. Lastly, we compared county‐level COVID‐19 mortality data for these FQHCs. Population Studied: FQHCs, excluding those in US territories, that received Section 330 funding 2010–2018 (N = 1258 in 2018). Principal Findings: Although the mean proportion of uninsured FQHC patients decreased from 38.2% to 23.9% from 2010–2018, more FQHCs were classified as having a high Section 330 revenue share: 7.9% in 2010 (N = 80) versus 16.2% in 2018 (N = 203). The positive association between annual changes in Section 330 funding and patient volume was greater for FQHCs classified as having high Section 330 revenue share vs. not (+0.05 percentage point greater increase in patient volume [95% CI: 0.03–0.07] for a 1‐ppt increase in funding). In 2018, compared to other FQHCs, those with a high Section 330 revenue share were smaller, more often located in the South (68.5% vs. 27.7%; aOR = 2.94, 95% CI: 1.27–6.81 vs. Northeast) and primary care shortage areas (57.6% vs. 30.1%; aOR = 1.92, 95% CI: 1.23–3.00), and less likely in Medicaid expansion states (35.5% vs. 77.7%, aOR = 0.33, 95% CI: 0.21–0.52). In bivariate analyses, FQHCs with high Section 330 revenue share were located in counties with higher mean COVID‐19 mortality rates (e.g., 102.2 vs. 84.8 deaths/100,000 for May–December 2020, p < 0.001). Conclusions: Patient volume was more responsive to changes in Section 330 funding for FQHCs with high proportions of uninsured patients and non‐patient revenue from Section 330 funds. FQHCs that could be more vulnerable to lapses in federal funding are more frequently located in the South, primary care shortage areas, states without Medicaid expansion, and counties with higher COVID‐19 mortality rates. Implications for Policy or Practice: These findings underscore the importance of longer‐term reauthorization of the CHCF to maintain consistent access to safety net care for underserved populations, including those disproportionately impacted by COVID‐19. Primary Funding Source: Agency for Healthcare Research and Quality. [ABSTRACT FROM AUTHOR]

Background: The Affordable Care Act expanded Medicaid and increased federal funding for Community Health Centers (CHCs). To examine the role of Medicaid coverage on care patterns for those with available safety net care, we assessed differences in access to care for CHC patients with continuous Medicaid coverage vs. gaps in insurance coverage in the last year.Methods: We used data on adult respondents from the 2014 Health Center Patient Survey (N = 1720) with continuous Medicaid coverage vs. those with some period without insurance coverage in the last 12 months. We examined reported need for any medical care, mental health care, prescription drugs, dental care, and referrals for care outside of the CHC in the last 12 months, and reports of being delayed or unable to get needed care by insurance status. We used logistic regression to assess the association between insurance status and care access, adjusting for patient characteristics.Results: Patients with insurance gaps and continuous Medicaid coverage reported similar levels of need for most types of care in the last 12 months, but those with insurance gaps were significantly more likely to report having difficulty obtaining medical care, prescription drugs, dental care, and completing outside referrals. Of those with incomplete referrals for care outside of the CHC, patients with insurance gaps were more likely than those with continuous Medicaid to cite cost or insurance-related reasons for not following up (70% vs. 19%, p < 0.01).Conclusions: Having continuous Medicaid coverage appeared to mitigate barriers to care for CHC patients compared to having intermittent or no insurance coverage over the last year. Policies that increase disruptions in Medicaid coverage could adversely impact access to care, even among those with available safety net care. [ABSTRACT FROM AUTHOR]

Introduction: Sexual orientation and gender identity data collection is necessary to address health inequities. This study examines sexual orientation and gender identity data reporting among community health centers.Methods: Using the 2016-2019 Uniform Data System for 1,381 community health centers, trends in reporting of sexual orientation and gender identity data were examined. Multivariable logistic regression was used to assess associations between community health center characteristics and whether sexual orientation and gender identity data were available for ≥75% of a community health center's patients in 2019. Data were analyzed in 2021.Results: In 2016-2019, the percentage of community health centers with sexual orientation and gender identity data for ≥75% of patients increased from 14.9% to 53.0%. In 2019, community health centers were more likely to have this data for ≥75% of patients if they were in nonmetro counties (OR=1.48, 95% CI=1.04, 2.10 versus metro), were in the South (OR=2.27, 95% CI=1.57, 3.31) or West (OR=1.91, 95% CI=1.27, 2.88 versus the Northeast), and had more patients aged between 18 and 39 years (OR=1.04, 95% CI=1.02, 1.07), between 40 and 64 years (OR=1.04, 95% CI=1.02, 1.06 vs <18 years), or veterans (OR=1.10, 95% CI=1.01, 1.20). This was less likely among community health centers serving 10,000-20,000 patients (OR=0.70, 95% CI=0.52, 0.95) and >20,000 patients (OR=0.44, 95% CI=0.32, 0.61 vs <10,000) and community health centers with more patients of American Indian/Alaskan Native (OR=0.98, 95% CI=0.97, 0.99) or unknown race (OR=0.92, 95% CI=0.86, 0.97 versus White).Conclusions: Collection of sexual orientation and gender identity data by community health centers has increased substantially since 2016, although gaps remain. [ABSTRACT FROM AUTHOR]