Heterogeneous Adoption of Medicaid Expansion and the State-Level Supply of FQHCs

Abstract

Federally Qualified Health Centers (FQHCs) are a crucial component of the American healthcare system. FQHCs provide comprehensive primary care services to millions of Americans in medically underserved areas and populations. Nearly 50 percent of patients treated at FQHCs have Medicaid (HRSA, 2021). The Affordable Care Act likely influenced the existence of FQHCs in two ways: increased funding through the creation of the Community Health Center Fund and Medicaid expansion (Rosenbaum et al., 2019; Behr et al., 2022). Medicaid expansion was adopted heterogeneously by states across the country. Evans et al. analyzed data from 10 states and found that the increase in access to FQHCs at the tract level was about the same in states that did and did not adopt the Medicaid expansion (Evans et al., 2022). In this study, we plan to expand on the work of Evans et al. and analyze state-level trends in FQHC supply in states that did and did not adopt the ACA Medicaid expansion. State-level analysis will examine trends in FQHC expansion using pseudo-experimental methods, comparing states that initially adopted the Medicaid expansion, states that eventually adopted the Medicaid expansion, and states that have not adopted the Medicaid expansion. This analysis will help elucidate the relationship between national policy and local healthcare access for medically underserved areas and populations. By exploring this relationship in more detail, scholars and policymakers can better understand if FQHCs are serving the populations in need and if there are populations still lacking access to essential primary care services.