While Community Health Centers draw revenue from Medicaid, Medicare, and commercial insurance, they rely heavily on federal funds to build, strengthen, and expand access to critical primary care services, especially for the 6.3 million people patients without coverage they are expected to serve by 2025. In this video, NACHC’s Director of Federal Affairs, Nicholas Widmyer, breaks down how Congress determines health center funding and how advocacy can make a difference.
NACHC Blog
Good oral health is crucial to overall health and well-being. Yet the nationwide shortage of dental health professionals poses a significant barrier to access to oral health. The federal government has designated more than 6,860 communities across the United States as having a shortage of dental health professionals. To address these gaps in oral health access, states should partner directly with health centers to ensure patients have access to the comprehensive and innovative services that health centers provide.
To assist with the expansion of the dental workforce, NACHC, in partnership with participating Primary Care Associations (PCAs) and community health centers, and with funding from the CareQuest Institute for Oral Health, recently released a guide on state policies and strategies to strengthen the dental workforce in health centers.
Health centers are one of the largest employers of dental health professionals
Health centers provide essential dental services to over 6.4 million patients including 1 in 8 children and 1 out of every 10 people living in the US. Health centers are one of the largest employers of dental health professionals, employing over 20,000 across nearly 1,500 service sites nationally.
State legislation can invest in and incentivize programs to support the dental workforce
Several State PCAs and health centers are seeking to address the shortage of healthcare workers, especially dental professionals, during their upcoming state legislative session. State legislatures are naturally prime leaders when it comes to advancing solutions to the dental workforce shortage. State legislatures have the authority to create state-based policies that establish resources for dental workforce programs such as state tax credits to support workforce housing or incentives for commercial insurers to partner with health centers. They also can show where their priorities are through their appropriation authority, meaning they can appropriate funds that invest in workforce development programs through grants for purchasing mobile clinics, professional training, student scholarships, loan repayment assistance programs, and more.
Health centers have a role to play in advocating for policies to support the dental workforce
Health centers and PCAs, on the other hand, are naturally some of the best partners to guide the implementation of these policies. Health center advocates should use real life examples to support your state’s implementation and ensure programs will actually benefit the patients and providers in the community.
This guide serves to help advocates identify existing models of state policies and effective strategies they can use when engaging with state lawmakers. The report breaks down the strategies into three buckets: Training, securing funds, and maximizing licensure.
Examples of strategies to expand the health center workforce
TRAIN: These involve state policies and strategies to expand health center-based training to strengthen workforce pathways and connect students to community health careers. Studies indicate that state investments in dental schools have lagged while there has been an increasing demand for services. Health centers are in a great position to partner with their State as a training site and a pipeline program for current and aspiring students. Health centers are usually located in communities with the greatest need, allowing students to gain practical experience while providing much-needed care to those in need.
“Shining Star” example: The Ohio Association of Community Health Centers (OACHC), the state’s PCA, negotiated funding with the Ohio Department of Health (ODH) for the Ohio Primary Care Workforce Initiative. This initiative provides funding to health centers to oversee the training and education of dental and other students of health professionals during their clinical rotations. Funding for the initiative has been appropriated biennially in ODH’s budget since 2015. This biennial appropriation is approximately $5.4 million and is administered by OACHC under a contract from ODH every two years to support clinical rotations.
SECURE: These are state policies and programs that establish workforce incentives that help health centers recruit and retain mission-oriented professionals. This includes state appropriations for scholarships, loan repayment, and policies promoting innovative program investments. To address the dental workforce shortage, States can partner with health centers and PCAs to develop incentives and resources to ensure dental providers enter the workforce and can continue serving health center patients.
For example, a scholarship program incentivizes individuals to seek employment at a health center and stay for longer periods of time because they receive money to obtain their degree and licensure in exchange for a work commitment. This type of program would reduce financial barriers, ensuring that the worry of student debt isn’t a main factor in their decision making.
“Shining Star” example: In 2022, Project Access was established to provide Nebraska FQHCs with flexible funding to expand and enhance access to quality, community-responsive care unique to their communities. As the state PCA, HCAN oversees these relationships, governs the Project Access Steering Committee, and completes required reporting for all funders and partners. This initiative was initially funded by Nebraska Total Care (a subsidiary of Centene) and the Centene Foundation.
Project Access was developed as an innovative means to increase access to care throughout the state. Since this time, additional Nebraska Medicaid Managed Care Organizations have come to the table and pledged a portion of their profits to aid the Nebraska health centers, their workforce, and their local communities.
MAXIMIZE: These include state policies and programs that encourage dental workforce innovations and authorize dental professionals to practice to the top of their license to extend capacity within health centers. Having every dental provider being able to work at the top of their training is an important way to grow the dental workforce and expand access to care. This means that providers will be able to provide the entire range of services and procedures they are trained in. Some state laws limit the scope of work a certain professional is allowed to provide.
This requires places like health centers to employ staff for specific services rather than allowing someone who is trained to deliver the care. In DHPSAs, there is the risk that there are not enough providers which could lead to the health center being unable to provide certain services. States can remove regulatory and/or policy barriers to licensure and scope of practice for dental health professionals to ensure each member of the dental care team is working at the top of their training.
“Shining Star” example: In 2011, the Oregon Legislature passed legislation that allowed the establishment of a dental pilot program strategy under the Oregon Health Authority to encourage innovation in oral healthcare delivery systems. Virginia Garcia Memorial Health Center participated in the established and approved pilot project #300 where experienced dental hygienists with a restorative endorsement were trained to become dental therapists, providing extended access to dental services in clinics and other community-based settings such as school-based clinics and mobile vans. This pilot is approved through January 2025, although many of the participants are now licensed dental therapists and no longer operate within the authority of the pilot. The success of the dental therapy pilot projects led to the Oregon Legislature to pass House Bill 2528 in 2021 which established the licensed role of dental therapists in the state.
Health centers working with policymakers can strengthen and expand the dental workforce
States have a critical responsibility to bridge the oral healthcare gap, especially for historically marginalized communities, and should partner with providers rooted in these communities to ensure patients’ needs are met. Health centers have long championed health equity with roots in the Civil Rights movement and are among the nation’s leading providers of dental care to under-resourced communities. There is a nonpartisan agreement that we must tackle the growing dental workforce shortage. This is the moment for health center advocates to work with their state legislatures to pass policies that help them reach a position where they are the provider of choice in their community. NACHC urges states to adopt the policies and best practices outlined in this report and inspire health centers in their state to become shining stars for oral healthcare as well.
The Accreditation Council for Graduate Medical Education (ACGME) is a national organization that determines educational standards for training physicians in various specialties such as family medicine, pediatrics, psychiatry and obstetrics and gynecology after they graduate from medical school. Such specialty training programs are also known as residencies.
Community Health Centers that serve as residency training sites through the Teaching Health Center Graduate Medical Education (THCGME) program or otherwise must abide by these standards to maintain accreditation, which can be a daunting task for smaller health centers with limited resources. Through the recently launched NACHC THCGME Task Force, health center leaders in GME asked NACHC to advocate with ACGME to ensure Community Health Centers can successfully train the next generation of the primary care workforce.
The ACGME periodically updates the standards they publish after inviting feedback through a public comment process. Most recently, ACGME was accepting comments on proposed revisions to their requirements for Sponsoring Institutions (SI) that are responsible for ensuring all aspects of physician residency training in their program meets ACGME’s requirements. NACHC submitted comments on these revisions expressing support for elements that would improve the quality of training and physician wellbeing while providing constructive feedback on aspects that could hinder health center-based residency program operations. NACHC’s comments are summarized below:
- NACHC commended ACGME efforts to enhance oversight of training standards at clinical sites and requested greater clarity on how a proposed requirement for only assigning trainees to sites that facilitate patient safety and care quality efforts would be implemented at programs that include training at Community Health Centers. NACHC asked ACGME to ensure redundant requirements do not inadvertently lead to duplication of effort that does not yield better outcomes.
- We noted that health center-based residency programs often rely on clinical learning environments that are distributed across multiple organizations and sites. Thus, it may not be feasible for a leadership team at just one Primary Clinical Learning Environment (PCLE) to be responsible for overall GME strategy. We suggested ACGME consider improving GME strategic oversight by requiring a leader from the PCLE to serve on the GME Committee overseeing the program and ensuring a diversity of perspectives is represented on the Committee. On a similar note, we expressed reservations about requiring Designated Institutional Officials (DIO) from having to hold an executive leadership role at the PCLE as this arrangement can be impractical to implement in training consortia comprising of Community Health Centers and other organizations.
- On the other hand, NACHC conveyed support for increased institutional support (including increasing salaries) for DIOs, administrators and other GME leaders, which might be scaled up based on the size and scope of oversight required. NACHC noted that without increasing administrative support, ACGME’s proposed revisions that would require increased analysis and reporting of organizational finances would be an undue burden on Community Health Centers, which have limited resources and operate on thin margins. Additionally, NACHC advised ACGME that requiring bylaws updates to rapidly be implemented at clinical sites such as health centers participating in a training consortium may not be feasible as participating organizations may have significantly different processes and timelines for bylaws updates.
- NACHC also expressed agreement with ACGME’s proposal to enhance protections for residents who might be exposed to disruptions in training as it would protect the wellbeing of trainers, trainees and other staff at health centers alike. Similarly, NACHC endorsed another initiative to improve residents’ training in diversity, equity and inclusion, but cautioned ACGME to avoid duplicating training at multiple sites covering the same content.
Overall, NACHC thanked ACGME for this opportunity to contribute feedback on proposed revisions to its institutional requirements and connected with ACGME to collaborate on future opportunities for improving the quality of residency training at Community Health Centers. If you would like more information about NACHC’s submitted comments and other engagement on workforce development, please contact FederalAffairs@nachc.org.
Approximately 19 million veterans live in the United States and many struggle to find the care they need. Community Health Centers are proud to help bridge these gaps by serving over 419,000 patients who identify as veterans increasing since 2020.
To meet this growing demand, health center program stakeholders, like the West Virginia Primary Care Association (WVPCA), are developing strategies and resources to help veterans with the complex health issues they may face from their military service. Veterans are a unique population to care for as their military experience can lead to various physical and emotional injuries.
A personal connection to veteran care
“Many veterans do not receive healthcare from the Department of Veterans Affairs (VA), and in fact turn to community providers who can be less knowledgeable about military-related health concerns such as military environmental exposures, Gulf War illness, agent orange, traumatic brain injury, sexual trauma, and women veterans’ health,” said Jessica Dailey Haas, RN, MSN, C-ONQS, Director of Clinical Transformation at WVPCA. “Recognizing that West Virginia (WV) health centers serve 1 in 3 WV residents, the WVPCA has committed to increasing training, resources, and assessments geared toward the veteran population.”
Haas’ motivation to care for veterans stems from her experience with her father, a 24-year U.S. Army Veteran who started experiencing military environmental exposure symptoms roughly 30 days upon returning from deployment.
Haas explains that her father worked round the clock and would not report to the “sick bay” while on deployment. Therefore, his records would not reflect him being subject to “exposure” while in the field. Upon his return, Haas’ father began showing unusual symptoms, and after obtaining lab work along with medical imaging of his thyroid from the local VA, he was instructed to “wait a year and monitor.”
However, Haas was not willing to settle for the “wait and monitor” approach when it came to her father’s health. Instead, they sought a second opinion from their community provider. After listening, reviewing the images and notes, Haas’ father was diagnosed with medullary thyroid cancer and sent to a specialized cancer specialist out of state.
“If the community provider had not taken the time to listen, review, and order additional imaging my father would not be with us today,” Haas said. “This is just one example of how our community providers have saved a veteran’s life.”
Health centers should use a new screening question to identify veterans
WVPCA actively participates in NACHC’s Veterans Interest Group, which seek to educate all health centers on the recommended screening question to best identify if a patient is a veteran.
According to 2023 UDS Data, WVPCA, West Virginia’s health centers and Look-Alikes served over 12, 000 veterans—approximately 20 percent of the state’s veteran population. Using evidence-based wording such as “have you served in the US military, armed forces or uniformed services,” can provide proven results for more accurate reporting on UDS, more robust needs assessment, and more tailored care and services to the veteran patient and their family.
Haas describes other ways WVPCA is improving clinical outcomes for veterans:
“In 2024, we continued our focus of improving veterans’ health in all our small clinical focus groups of colorectal cancer screening, hypertension, and diabetes. This fall, WVPCA joined Emergency Care Research Institute’s (ECRI) Service, Academics, Leadership, Unity, Tribute, and Excellence (SALUTE) Honor Roll Program and discussed the ECRI SALUTE tools in each of the monthly peer groups as well as shared the resources on our WVPCA community learning platform.”
Haas acknowledges that to avoid misdiagnoses of symptoms, like her father experienced, we must ensure that providers and health centers are given the resources to effectively serve this vulnerable population. To do so, we must:
- Ask the right questions—have you served in the armed forces such as the US Army, Marines, Navy, Airforce, Coast Guard, Space Force, or Public Health Corporation?
- Provide screening questions—have you served during combat? Were you exposed to environmental toxins. Burn pits, agent orange? Did you experience traumatic brain injury?
- Provide clinical training on Gulf War Illness, military environmental exposure, agent orange
- Document using appropriate screening such the Center for Disease Control (CDC) and Kansas case definition for Gulf War illness
- Provide resources to caregivers
- Provide resources to veterans
“NACHC is committed to supporting health centers serving veterans in their communities,” said Gina Capra, Chief Education Officer at NACHC. “NACHC works with health centers on a range of topics including increasing access to care for veterans and their family members and helping to establish partnerships with the US Department of Veterans Affairs and veteran-focused organizations in local communities.”
Resources from NACHC to improve care for veterans
Haas served as faculty on NACHC’s October 17 national webinar featuring the ECRI toolkit to improve care for military veteran patients in health centers.
Learn more about how health centers provide care to veterans, or access resources and webinars to expand your ability to reach veteran patients.
In the month of November, as we observe Native American Heritage Month, we honor the Community Health Centers committed to serving more than 400,000 Native American and Indigenous patients. Native American Heritage Month recognizes the rich heritage and significant contributions of Native American and Indigenous peoples. As we honor Native American Heritage Month, we recognize the vital role of health centers in providing culturally competent care to address health disparities and improve overall health outcomes of Native American and Indigenous communities.
Health disparities within Native American and Indigenous communities are a pressing concern, as their life expectancy falls 4.4 years short of the general U.S. population, and they experience disproportionately higher rates of preventable illnesses like diabetes, chronic liver disease, cirrhosis, and chronic lower respiratory diseases. Health centers are instrumental in addressing these disparities, improving health outcomes, and restoring justice and respect for these communities’ heritage and resilience.
Health centers address disparities and restore justice and respect for Native communities
Federally qualified health centers like the Native American Community Clinic (NACC) and NATIVE HEALTH play a crucial role in providing comprehensive healthcare services to Native American communities nationwide. The Native American Community Clinic (NACC) in Minneapolis, Minnesota, led by Dr. Antony Stately, the center’s first Native American CEO, is dedicated to promoting the physical, mental, and spiritual well-being of Native American families.
Dr. Stately, a member of the Ojibwe and Oneida tribes, understands the unique concept of health held by many Native Americans, which often encompasses broader factors than those found in mainstream Western culture. At NACC, he works to integrate traditional healing practices with Western medicine, emphasizing the importance of spirituality, family wellness, community well-being, and personal balance.
NACC offers a wide range of services, including general healthcare, chronic disease management, preventive care, mental health support, substance abuse programs, support groups, dental care, and access to spiritual care and traditional healing practices. Committed to addressing health disparities and promoting equity, NACC serves Native American families in the Twin Cities area. As Dr. Stately says:
“Before we can improve the health of individuals and communities, we must carefully consider our work—its purpose and who it benefits. We’re on that path, moving forward in a new direction.”
NATIVE HEALTH provides holistic and culturally sensitive services
NATIVE HEALTH, a Community Health Center in Phoenix, Arizona, provides holistic, patient-centered, and culturally sensitive health and wellness services. They offer a comprehensive range of care, including primary medical care, dental services, behavioral health support, and community health programs. Grounded in Indigenous Values, NATIVE HEALTH integrates traditional practices into all aspects of their services.
From virtual Talking Circles and a Traditional Garden to Cultural Group Connections and early childhood programs, the center offers a variety of opportunities for community members to connect with their cultural heritage.
For example, NATIVE HEALTH hosts an annual Traditional Children’s Pageant where Native American youth showcase their traditional regalia and perform indigenous activities. Judged by Tribal Royalty, this popular event fosters pride in heritage, encourages youth to continue their traditions, and highlights the connection between health and cultural celebration.
As Susan Levy, NATIVE HEALTH’s Communication Coordinator and Volunteers/Community Involvement leader, explains, “This event fosters a sense of pride and belonging among Native American youth while promoting a positive connection between health and culture.”
Overall, the NATIVE HEALTH team embodies the center’s core values of being ever-present, supportive, and culturally responsive to the Native American and Indigenous People communities.
Both health centers are part of a network of health centers that collectively serve over 500 tribes nationwide, ensuring that Native American communities receive the care and support they need to thrive. As we celebrate Native American Heritage Month, it’s important to recognize the invaluable contributions of health centers like NACC and NATIVE HEALTH.
By addressing health disparities and promoting health equity, these health centers are instrumental in enhancing the overall well-being of Native American communities. Their dedication to preserving and celebrating the diverse traditions and resilience of these communities is essential for securing a future where Native American and Indigenous peoples not only have access to quality healthcare but also thrive within their rich cultural heritage.
Let’s work together to support these remarkable health centers and spread awareness about their crucial role in achieving health equity. By sharing this blog post, we can celebrate the resilience and traditions of Native American and Indigenous peoples throughout the year, not just during Native American Heritage Month.
NACHC sent the White House Office of Management and Budget a letter requesting that the Biden administration include in any supplemental funding request from Congress a set-aside for Community Health Centers affected by Hurricane Helene, Hurricane Milton, and other disasters since 2022.
“As safety net providers operating on razor-thin margins, health centers – and their communities – will struggle to recover from these disasters without dedicated federal support.
Community Health Centers are the best, most diverse, most innovative, and most resilient part of our nation’s health system. For nearly 60 years, health centers have provided high-quality, comprehensive, affordable primary and preventive care, dental, behavioral health, pharmacy, vision, and other essential health services to America’s most vulnerable, medically underserved patients in urban, rural, suburban, frontier, and island communities. Today, health centers serve 1 in 10 Americans at over 16,000 locations. Health centers recently reached a historic milestone of serving over 32.5 million patients, including nearly 10 million children and over 400,000 veterans. They provide care to one in seven rural residents, one in nine Medicaid beneficiaries, and one in five uninsured persons.
Hurricanes Helene and Milton affected dozens of health centers across the southeast of our country, disrupting operations and causing severe hardship for health centers’ staff and patients. When health centers are knocked offline, diabetic patients miss appointments, pregnant women miss prenatal visits, children miss routine vaccinations, and behavioral health patients have their therapy interrupted. These interruptions in care not only worsen patients’ health but also lead to an increase in avoidable hospitalizations and emergency department visits, further straining a healthcare system that is otherwise focused on emergency response.”
Related:
Read NACHC’s coverage of health centers and disaster response.