Johns Hopkins School of Public Health
Community Health Centers (CHCs) are private, non-profit organizations that directly or indirectly
(through contracts and cooperative agreements) provide primary health services and related services to
residents of a defined geographic area that is medically undeserved. Community health centers are
authorized under Section 330 of the Public Health Service Act, 42 USC, 254b. Section 330 was revised
in 1996 by the Consolidated Health Centers Act, which combined community health centers with migrant
health centers, health care for the homeless, and public housing health care programs. Section 330 health
centers receive grant funding from the federal government (about 26% of revenue) and reimbursement
from Medicaid (35%). They are also supported by other federal grants, state and local grants or
contracts, private grants, Medicare, private insurance, and patient fees.
Community health centers have a three-fold mission. First, CHCs aim to improve access to care for low
income, underserved, vulnerable populations. They are required to be located in medically-underserved
rural and urban areas, and within those communities, they serve those with limited access to more
mainstream health care. Second, CHCs provide a fully comprehensive range of primary care services,
including "enabling" or support services. Third, true to their roots in the community activism of the
1960s, they involve the community in both the management and governance of the center.
In FY 1996, there were 685 federally-funded CHCs, operating 3,032 sites across the country, serving
over 8 million people. A large proportion of health center patients are children (42 %) and women of
childbearing ages (39 %). CHCs also serve a high proportion of minorities, with 33 percent of users
African American, 29 percent Hispanic, and 5 percent Asian or Pacific Islander.
A majority of health center patients are either uninsured (41 %) or on Medicaid (33 %). The rest are
private paying (17 %), on Medicare (8 %), or have other forms of public insurance, such as state health
insurance (8 %). Fifty-nine percent of health care patients are below the poverty level, and another 20
percent are between 100-200 percent of poverty. Because of their lower socioeconomic status, many
health center patients have pressing health care needs.
Community health centers are required by law to provide "primary health services," and "additional
health services as necessary to the residents of the area served by the center (otherwise known as the
"catchment area"). "Primary health services" are defined as 1) health services related to family
medicine, internal medicine, pediatrics, obstetrics, or gynecology, 2) diagnostic laboratory and radiologic
services, 3) preventive health services, 4) emergency medical services, and 5) pharmaceutical services.
Additionally, health centers provide referrals to providers of substance abuse and mental health services,
patient case management services, enabling services such as transportation and language services, and
patient education. When appropriate for the population, health centers also provide environmental health
services and migrant/agricultural workers services.
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1. This definition describes community health centers that are supported by federal grants and financing.
There are many other types of health centers operating in the U.S. health care system, that receive public or charity
funding (e.g. "free clinics" or health centers affiliated with hospitals, etc). With the growth in outpatient,
community-based care, the number of health centers has grown. Unfortunately we do not have systematic data on
these other types of health centers.