FQHC Glossary

A federal program that requires pharmaceutical manufacturers to offer discounted prices on drugs to covered entities like FQHCs. This can save millions annually on medication costs.

A network of healthcare providers (hospitals, clinics, FQHCs) aligned to jointly manage patient populations and improve outcomes under value-based contracts. Shares savings if quality improves and costs decrease.

Reimbursement methods other than fee-for-service, such as capitation or value-based payments where providers share risk and potential savings. FQHCs increasingly use APMs.

Healthcare services addressing mental health conditions (depression, anxiety) and substance use. Many FQHCs integrate behavioral health into primary care to address SDOH and improve outcomes.

A regional organization contracted by Medicaid to manage behavioral health services, approvals, and claims. FQHCs often coordinate with BH-ASOs to deliver mental health care.

California's multi-year initiative to strengthen Medicaid by expanding behavioral health services, addressing social determinants of health, and improving care coordination through enhanced programs like ECM.

A CalAIM component providing Medi-Cal funding for social services like housing assistance, nutrition, and transportation—addressing social determinants of health. FQHCs refer patients to these supports.

A state program supporting climate-resilient healthcare infrastructure. FQHCs can apply for funding to upgrade facilities, solar, or backup power to handle climate emergencies.

A Medicare program that reimburses FQHCs for comprehensive care coordination for patients with multiple chronic conditions. Different from ECM but serves similar patients.

A large California nonprofit foundation that funds health policy research and healthcare initiatives. Publishes key analyses on FQHC funding impacts and healthcare access.

A frontline health professional who bridges clinics and communities—conducting outreach, health education, care coordination, and social support. CHWs are integral to FQHC service delivery in California.

Federal standards requiring healthcare organizations to provide culturally competent and linguistically accessible services. CLAS standards guide FQHC interpretation, translation, and cultural competency training.

The federal agency that administers Medicare and Medicaid programs and sets reimbursement rates for FQHCs. CMS regulations directly impact FQHC revenue and operations.

The state trade association representing California's FQHCs. Advocates for FQHC policy, funding, and workforce issues at the state level.

California's state agency that administers Medi-Cal (California's Medicaid program) and contracts with health plans, BH-ASOs, and FQHCs. Sets state-level healthcare policy affecting FQHC operations.

California's state public health agency. Works with FQHCs on disease surveillance, emergency response, vaccination programs, and health equity initiatives.

A Medi-Cal program that pays FQHCs to coordinate care for high-risk patients through home visits, care planning, and referrals to social services. Eligible patients include those with serious health conditions or social barriers to health.

A digital system that stores patient medical records, test results, medications, and visit history. Most FQHCs use EHRs for clinical care, billing, and quality reporting.

A Medicaid benefit requiring comprehensive preventive care and treatment for children under 21. FQHCs provide EPSDT screening and ensure access to specialty care referrals.

The federal government's share of Medicaid spending for a state. Higher FMAP means more federal funding for Medicaid services. California's FMAP affects FQHC Medicaid revenue.

The income threshold set by the federal government used to determine eligibility for programs like Medicaid and sliding fee scales. FQHCs serve patients up to 200% FPL.

A nonprofit health center that receives federal funding (Section 330 grants) to serve uninsured and low-income patients in medically underserved areas. FQHCs provide comprehensive primary care and preventive services regardless of a patient's ability to pay.

A measure of workforce size. One FTE equals one full-time employee (40 hours/week). Part-time staff are counted as fractions (e.g., 0.5 FTE for 20 hours/week).

Proposed federal legislation (2025-2026) to slash Medicaid funding by $4.6B, cut undocumented Medicaid, eliminate ECM, and reduce FQHC reimbursement. Major threat to FQHC sustainability.

The California agency responsible for healthcare workforce programs, facility licensing, and health workforce development initiatives including CHW certification.

A set of standardized quality measures used to track healthcare performance in areas like diabetes control, preventive care, and medication use. FQHCs report HEDIS data to health plans.

The federal department overseeing health programs including Medicare, Medicaid, HRSA, and CMS. Sets national health policy affecting FQHCs.

The federal agency within the U.S. Department of Health and Human Services that funds FQHCs through Section 330 grants and oversees their operations and reporting requirements.

A network of independent physicians and clinics that contract together with health plans to provide care and manage capitated risk. FQHCs sometimes partner with IPAs for capitated contracts.

A nonpartisan nonprofit organization producing health policy research and analysis. Known for Medicaid data, healthcare coverage tracking, and policy briefs.

Evidence-based treatment using medications like buprenorphine or methadone to treat opioid addiction. Many FQHCs provide MAT/MOUD services integrated with primary care.

California's Medicaid program that provides health coverage to low-income individuals and families. Medi-Cal is the largest payer for FQHC services in California.

The national trade association representing FQHCs and community health centers. Advocates for FQHC funding, policy, and workforce issues at the federal level.

A federal loan repayment and scholarship program that helps clinicians pay off student loans in exchange for working at FQHCs and other underserved settings. Popular among physicians and nurses.

A shared Electronic Health Record system used by many California FQHCs. Allows for data sharing across organizations to improve care coordination and quality reporting.

A federal monitoring visit where HRSA staff inspect an FQHC's operations, financial management, clinical services, and compliance with Section 330 requirements.

An intermediary company that processes prescription drug claims between FQHCs, pharmacies, and health plans. PBMs negotiate drug prices and manage formularies.

A model of care where the FQHC coordinates all aspects of patient health—primary care, specialist referrals, mental health, and social services—with the patient's primary clinician leading the care team.

A reimbursement method for FQHCs where Medicare and Medicaid pay a per-visit rate based on the center's costs, adjusted annually. This allows FQHCs to be reimbursed fairly regardless of which patients they serve.

A billing metric that assigns points to medical services based on complexity and time. Under RVU-based payment, higher RVU services generate more revenue—can incentivize inappropriate coding.

A federal program providing funding to FQHCs and other providers for comprehensive HIV care, treatment, and support services. Covers patients without other insurance.

California law requiring FQHCs and other covered employers to pay healthcare workers at least $25 per hour by 2027. This affects FQHC payroll budgets significantly.

The federal statute that defines FQHCs and authorizes federal funding (grants) for community health centers. Requires FQHCs to serve all patients regardless of ability to pay and insurance status.

A payment model where patients pay fees based on their income and family size, from free to full cost. Required of all FQHCs to ensure affordability and access for low-income patients.

A medical condition involving the misuse of substances (drugs, alcohol) that causes significant functional impairment. FQHCs integrate SUD screening, treatment, and recovery support into primary care.

A Medi-Cal program that reimburses FQHCs for case management services for specific populations, such as homeless individuals or those with chronic conditions. More targeted than ECM.

A federal program funding family planning and reproductive health services at FQHCs and other clinics. Provides contraception, STI testing, and cancer screening regardless of income or insurance.

A federal data collection system where FQHCs report clinical, financial, and operational performance metrics to HRSA. Used to assess quality, access, and fiscal health.

A variant of RVU that includes work time, practice expense, and malpractice. Used by some clinicians to track productivity. Concerns exist about overuse incentivizing higher-complexity coding.