Community Health Centers’ Pandemic Experiences by State Medicaid Expansion Status: Reported Differences in COVID-19 Vaccination Rates and Weekly Visit Declines

By Rebecca Morris, Finn Dobkin, Jessica Sharac, Feygele Jacobs, Peter Shin

Throughout the COVID-19 pandemic, states have had vastly different experiences with case rates, restrictions, testing, and vaccination rates. Similarly, community health centers’ experiences have varied widely by state, although all health centers serve medically underserved communities with high proportions of racial and ethnic minorities and low-income individuals. As a consequence of high unemployment rates and associated losses of employer-based insurance, the availability of Medicaid, and thus the status of state Medicaid expansion, is of heightened importance for these vulnerable patients and the financial stability of the health centers that serve them. In 2019, before the pandemic, more than half (53 percent) of all patients served by community health centers in Medicaid expansion states were enrolled in Medicaid compared to only 32 percent in non-expansion states; accordingly, Medicaid revenue accounted for 48 percent of total revenue for health centers in Medicaid expansion states compared to only 28 percent for those in non-expansion states. Health centers in Medicaid expansion states, on average, report higher total revenue and operate more sites, serve greater numbers of patients, provide more visits, and employ greater numbers of staff members, compared to non-expansion state health centers.

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