Community health centers (CHCs), the backbone of America’s health care safety net, report worsening workforce shortages, a new Commonwealth Fund survey finds. In 2024, more than 70 percent of CHCs have reported primary care physician, nurse, or mental health professional shortages.
The survey also shows that, despite many challenges — including rising mental health and substance use treatment needs, changes in Medicaid enrollment, and persistent funding gaps — CHCs have continued to provide accessible, comprehensive, and coordinated health care to more than 30 million patients annually. Of these, 20 million are people with low income, 17 million are people of color, 15 million are people covered by Medicaid or the Children’s Health Insurance Program, and nearly 16 million are uninsured.
Also known as federally qualified health centers, CHCs are community-based outpatient clinics that provide an array of services. They’re supported through a combination of federal funding, Medicaid reimbursement, and other revenues. At the time of the survey, 1,368 centers were operating in more than 15,000 service areas.
The 2024 Commonwealth Fund Survey of Federally Qualified Health Centers engaged nearly 740 CHC leaders nationally to assess the extent to which CHCs achieve the core functions of primary care — accessibility, comprehensiveness, and coordination — and the barriers they face in doing so. It also explores how care delivery has changed since 2018, when the survey was last conducted.
Other key findings include:
• Timely appointments and flexible hours: Nearly all community health centers offer timely appointments (88%) and expanded hours for patients to receive care (93%).
• Rising telehealth: The availability of telehealth services through CHCs has skyrocketed since 2018, rising from 24 percent to 96 percent in 2024. Sixty-one percent of CHCs report that telehealth has improved patients’ access to specialty care.
• More substance use treatment: Significantly more CHCs offer substance use disorder treatment (66%) and medication-assisted treatment (62%) in 2024 compared to 2018 (54% and 37%, respectively).
• Screening for social needs: Significantly more CHCs reported screening patients for unmet social and economic needs. Overall, 67 percent of CHCs reported screening all patients for unmet social needs in 2024, compared to 40 percent in 2018.
• Challenges in coordinating with specialists: Most CHCs struggle to obtain specialty care appointments for their patients (73%), particularly for those covered by Medicaid or those lacking insurance.
POLICY IMPLICATIONS
The challenges facing CHCs — workforce shortages, thin financial margins, and coordinating care with other providers — threaten their ability to continue providing high-quality care. But there are policies that could, if enacted by Congress, better support CHCs:
• Reauthorize and expand the Community Health Center Fund. This key source of federal funding is set to expire at the end of 2024. Congress could reauthorize multiyear funding for the program and increase the amount of funding.
• Address growing workforce shortages. Congress could take steps to expand recruitment, retention, and training programs that encourage providers to practice in medically underserved areas, including rural communities.
• Ensure that CHCs have sufficient resources to continue offering telehealth. This can be done by aligning telehealth reimbursement more closely with reimbursement for in-person care. Congress can extend federal flexibilities that enabled CHCs to expand telehealth use during the pandemic, such as higher payment rates, which are set to expire at the end of 2024.
![Image: [image credit]](/wp-content/themes/yootheme/cache/fe/dreamstime_xxl_168278622-scaled-fefd79b5.jpeg)
