Community Health Centers

Federally Qualified Health Centers (FQHCs) are one of the US healthcare system’s most important safety-net resources. Funded through the Health Resources and Services Administration (HRSA) under the Health Center Program, FQHCs are required by law to provide primary care to all patients in their designated service area, regardless of ability to pay, insurance status, or immigration status. With thousands of service sites across the country, they are often the most accessible source of comprehensive primary care for uninsured and low-income individuals.

What makes a health center an FQHC

To receive federal funding and the designation of Federally Qualified Health Center, a facility must meet specific requirements:

• Located in a federally designated medically underserved area or serving a medically underserved population
• Governed by a patient-majority board of directors
• Providing comprehensive primary care services
• Adjusting fees using a sliding scale based on ability to pay
• Seeing all patients regardless of ability to pay or insurance status
• Meeting quality, financial, and administrative standards set by HRSA

These requirements distinguish FQHCs from ordinary clinics. The federal designation comes with enhanced reimbursement rates from Medicare and Medicaid (the Prospective Payment System rate), access to the 340B Drug Pricing Program, and federal tort liability protection for malpractice claims.

Services available at FQHCs

The scope of services at FQHCs is broader than at many private primary care offices. Required services include:

Primary medical care: Preventive care, chronic disease management, acute illness treatment, immunizations, and health screenings.

Dental services: Preventive and restorative dental care, which is often not covered by Medicaid for adults and is unavailable to many uninsured individuals anywhere else affordably.

Mental health and behavioral health: Counseling, therapy, psychiatric medication management, and substance use treatment — often fully integrated with primary care at the same site.

Pharmacy: Many FQHCs have on-site or affiliated pharmacies that participate in the 340B Drug Pricing Program, allowing them to purchase outpatient drugs at significantly reduced prices and pass savings to patients.

Case management and social services: Navigation assistance for benefits enrollment, housing, food access, transportation, and other social determinants of health.

Enabling services: Translation and interpretation, transportation assistance, and health education.

Not every FQHC location offers all of these services. Some sites are full-service health centers; others are specialized (dental-only, mental health-focused, mobile units). Use the HRSA health center finder to identify what is available near you.

How the sliding fee scale works

The sliding fee scale is the mechanism that makes FQHC care accessible to patients who cannot afford standard rates. The scale is based on household income as a percentage of the federal poverty level (FPL), which is updated annually by the federal government.

• Patients with income at or below a defined low-income threshold (set by the health center within HRSA guidelines) pay nothing or a nominal flat fee.
• Patients with income above that threshold but below full cost capacity pay on a sliding scale, with fees rising as income increases.
• Patients above the full fee threshold pay the health center’s standard (but still negotiated) rates.

To apply the sliding scale, the health center may ask for documentation of income — pay stubs, tax returns, or a self-reported income statement. However, federal rules require that health centers provide care even if you cannot produce documentation. Patients who are unable or unwilling to document income are typically placed at the lowest fee level.

Finding an FQHC near you

HRSA maintains an online health center finder at hrsa.gov/find-health-center. You can search by zip code or address for the nearest FQHC locations with contact information, services, and hours. You can also call the health center to ask about services, waiting times for new patients, and what to bring to your first appointment.

For patients who are also Medicaid-enrolled, FQHCs are required to accept Medicaid, and the Prospective Payment System rate is generally more favorable to the health center than standard Medicaid rates. This means FQHCs often have more capacity to accept Medicaid patients than private practices.

Using FQHC services with insurance

If you have health insurance — Medicaid, Medicare, or private coverage — the health center bills your insurer and charges you your plan’s normal cost-sharing. Your FQHC visit is treated as an in-network primary care visit if the FQHC participates in your plan’s network. Being seen at an FQHC does not require that you be uninsured.

If you have high-deductible private insurance and cannot afford the deductible, the sliding fee may result in a lower patient cost than going to a standard primary care clinic where you would pay the full deductible amount for the same service.