# Federally Qualified Health Centers and Care for Vulnerable Populations

> **NIH AHRQ R01** · MASSACHUSETTS GENERAL HOSPITAL · 2021 · $318,002

## Abstract

The Patient Protection and Affordable Care Act (ACA) substantially increased federal funding for federally
qualified health centers (FQHCs), providing $11 billion from 2011 to 2015 to expand existing FQHCs and
establish new health centers. The goal of this funding was to bolster the supply of primary care in underserved
areas to meet some of the anticipated increases in demand for care associated with ACA insurance coverage
expansion, particularly among lower-income Americans. Millions of lower-income Americans gained coverage
starting in 2014 due to Medicaid expansion and the provision of low-income subsidies for marketplace
coverage. To date, however, there is little evidence on whether funding increases for FQHCs are associated
with improvements in care or outcomes for the communities they serve. We will examine the effects of
changes in federal FQHC funding on three sets of outcomes: 1) outpatient care, including primary and
specialty care visits, sources of care (e.g., FQHC vs. non-FQHC), and sentinel preventive care quality
measures; 2) downstream clinical events, including emergency department visits (for emergent and non-
emergent conditions), hospitalizations (overall and for ambulatory care sensitive conditions), and mortality; and
3) total and component spending (e.g., outpatient, inpatient, pharmacy). We will focus on the experience on
Medicaid beneficiaries because they were a central focus of the policy and because we are able to examine
comprehensive, beneficiary-level claims data on utilization, diagnoses, and spending over time, and across
sites of care for this population. We will use a staggered implementation design with a dose-response
model (where dose is determined by the amount of funding) to compare changes in outcomes for beneficiaries
living in areas that received larger vs. smaller increases in per capita federal FQHC funding. Because funding
levels could be associated with the baseline capacity or quality of the FQHCs, we will use a fixed effects
estimation approach to account for unmeasured time-invariant differences across individuals, FQHCs, and
local areas. We will also adjust for a range of time-changing covariates to reflect potential changes in
individual- (e.g., comorbidities) or area-level demand for care (e.g., insurance coverage mix), as well as area-
level provider supply using linked datasets (e.g., American Community Survey). We will examine separately
the experiences of: 1) beneficiaries who were continuously eligible for Medicaid (categorically needy), before
and after the funding increases (2007-2017); and 2) beneficiaries newly eligible for Medicaid in 2014 (adults
with incomes <138% FPL) over the period 2014-2017, during which time there is ongoing variation in FQHC
funding. The ACA's Community Health Center Fund was extended in 2016-2017 at $7.2 billion; however,
funding after 2017 is uncertain. This study will provide the first information on the effects of changes in FQHC
funding during a dynamic...

## Key facts

- **NIH application ID:** 10167765
- **Project number:** 5R01HS025378-05
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Vicki Fung
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $318,002
- **Award type:** 5
- **Project period:** 2017-08-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10167765

## Citation

> US National Institutes of Health, RePORTER application 10167765, Federally Qualified Health Centers and Care for Vulnerable Populations (5R01HS025378-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10167765. Licensed CC0.

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