Conclusion

A comparison of health center data from 2020 and 2019 and earlier trend data show the clear effect of the COVID-19 pandemic on health centers, the volume of care provided, and the number patients. From 2019 to 2020, the number of total patients fell by four percent and the number of children served declined to a much greater degree, by 14 percent. While the rapid expansion of virtual visits helped to offset a 30 percent decline in in-clinic visits, health center visits fell by seven percent overall, with visits declining across most service types. Data from HRSA’s Health Center COVID-19 Survey reveal that health centers, like other providers, face a continuing challenge in their ability to recover to full operational capacity; as of September 2021, visit volume was down by seven percent compared to pre-pandemic visit volume, and 315 sites were temporarily closed as of mid-August 2021.[25] In order to meet pent-up demand for care delayed earlier in the pandemic as patients return to normal health care utilization patterns, community health centers will need to have the staffing and capacity to serve them. For example, as students return to in-person school, school-based health center sites that were temporarily closed will need to re-open to serve the children and adolescent patients who received fewer health services in 2020 to avoid long-term health consequences of their delayed or forgone care.

Still, despite unprecedented conditions, community health centers succeeded in testing millions for COVID-19 and treating three-quarters of a million patients diagnosed with COVID-19 illness. Health centers also increased their provision of mental health visits, and more patients received MAT services for opioid use disorder in 2020. That they were able to do so in the face of a historic pandemic reflects their role as essential providers for medically underserved communities, deep community roots, and the infusion of COVID-19 specific funding to both enable their COVID-19 response and to support their traditional provision of care.

However, substantial challenges remain. As trusted providers long embedded in their communities, community health centers have a history of reducing health disparities and increasing access to and providing high-quality care.[26] Despite this, 2020 UDS data report decreased performance on certain quality measures and reduced numbers of diagnostic screenings and preventive services, which could have longer-term health consequences for health center patients. Furthermore, with the Delta variant and uneven vaccination rates across the country causing a surge in COVID-19 cases, the COVID-19 pandemic is far from over, meaning that community health centers are facing the continued burden of providing COVID-19 diagnostic testing, vaccines, and booster shots[27] while scaling up their routine services.

Community health centers may face an additional, major challenge in the coming months that will further strain clinical and financial recovery. Continuous  Medicaid enrollment during the pandemic emergency period and enhanced Medicaid funding[28] has likely prevented Medicaid revenue declines. When the public health emergency period ends, millions of patients whose coverage has remained stable over the past 18 months will need to undergo eligibility redeterminations, increasing the risk of coverage interruption. In some cases, actual changes in patients’ financial, household, or health status may lead to the loss of coverage. In other cases, the process of updating eligibility can cause enrollment lapses due to information being incomplete, or not provided in a sufficiently timely fashion. The need to intensively help patients navigate what can be a complex renewal and review process is likely to place added strains on health center outreach and eligibility assistance staff, a fact that underscores the importance of additional federal grant funding to assist health centers in meeting the need for additional staffing to help their patients with this process.

Finally, the situation facing community health centers serving patients in the 12 remaining Medicaid non-expansion states[29] disproportionately concentrated among the states with the highest COVID-19 caseloads[30] remains a national matter of great concern. People falling into the coverage gap in these states – ineligible for Medicaid but too poor for Marketplace subsidies – are disproportionately Black and Latino,[31] making the coverage gap a major source of health inequity and a seriously limiting factor in health centers’ financial capacity to meet community need. Legislation now pending in Congress would close this gap through a combination of near-term highly subsidized plans, followed by a permanent federal Medicaid program serving eligible people in non-expansion states. Should this legislation become law, its coverage and care impact on residents of non-expansion states merits close monitoring.