Federally qualified health centers (FQHCs) provide preventive and primary health care to patients regardless of their ability to pay. FQHCs are public and private non-profit health care organizations that comply with Federal requirements to: serve a medically underserved population, and provide appropriate and necessary services with fees adjusted on patients’ ability to pay.
FQHCs receive a unique form of Medicaid reimbursement called the Prospective Payment System (PPS). Each FQHC clinic has its own per-visit PPS payment rate for any visit by a patient with Medicaid, regardless of the length or intensity of the visit, which is meant to recognize the costs and scope of services provided by that clinic.
Most FQHCs apply for and receive Health Center Program grant funding through the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) but the majority of their revenue comes from Medicaid, Medicare, private insurance, patient fees and other resources. Some FQHCs meet all health center program requirements, but do not receive health center grant funding. These are called FQHC look-alikes.
Eleven public health care systems operate FQHC clinics as part of their integrated systems of care, and are therefore represented by CAPH. CAPH partners closely with the California Primary Care Association, which represents the state’s non-profit, private FQHCs.
Read our fact sheet: California’s FQHC Payment Reform Pilot