Key Takeaways
Neighborhood well being facilities are a nationwide community of over 1,300 safety-net major care suppliers, serving greater than 30 million sufferers in 2022. They’re positioned in medically underserved city and rural communities and serve all sufferers no matter their potential to pay. Well being facilities additionally performed a serious position within the nation’s response to the coronavirus pandemic, significantly for hard-to-reach populations. This transient analyzes the adjustments in well being middle sufferers, companies, and financing from 2019 (pre-pandemic) by 2022 utilizing the Uniform Information System (UDS), to which all well being facilities are required to report yearly. Key takeaways embrace the next:
The well being middle affected person inhabitants has returned to pre-pandemic ranges after dipping through the first 12 months of COVID and is up barely from 29.8 million sufferers in 2019 to 30.5 million in 2022 (2%). However the variety of youngsters served by well being facilities decreased considerably from 9.2 million to eight.8 million (4%) throughout the identical interval, with the best decline amongst youngsters ages 0-5. There’s proof indicating that utilization of major and preventive companies amongst youngsters on Medicaid stays under pre-pandemic ranges, which can partially clarify the drop in pediatric sufferers at well being facilities.
Well being facilities disproportionately served communities of coloration and low-income folks—63% of sufferers had been folks of coloration and over 90% had revenue that was at or under 200% of the federal poverty stage in 2022.
Extra folks had been returning to in-person care because the begin of the pandemic, with over 105 million well being middle affected person visits performed in-person in 2022 as in comparison with 85.7 million in 2020, however telehealth was nonetheless utilized in 17% of all visits in 2022.
From 2019 to 2022, the variety of visits for psychological well being and substance use dysfunction companies elevated 21%, with massive will increase in variety of sufferers identified with anxiousness problems (26% enhance) and a spotlight deficit problems (21% enhance). The variety of sufferers receiving medication-assisted remedy (MAT) for opioid use dysfunction elevated 36% from 2019 to 2022.
From 2019 to 2022, the share of well being middle sufferers who’re uninsured dropped from 23% to 19%, whereas the share of sufferers coated by Medicaid elevated from 49% to 51%, doubtless because of the Medicaid steady enrollment provision that was in place from March 2020 by March 2023.
Medicaid was the most important income supply for well being facilities, offering 42% of all income in 2022 whereas federal grant funding comprised 12% of whole funding. Well being middle revenues elevated by over $11 billion since 2019, primarily as a result of development in Medicaid funding associated to the rise in Medicaid sufferers and COVID-related funding.
The unwinding of the Medicaid steady enrollment provision will doubtless influence well being middle sufferers, companies, and financing beginning in 2023 as people who find themselves disenrolled from Medicaid enroll in different protection or turn into uninsured. KFF monitoring signifies that greater than 20 million folks have been disenrolled from Medicaid because the begin of the unwinding. Early analysis performed utilizing well being middle claims knowledge discovered that 17% of sufferers who had been coated by Medicaid previous to the beginning of unwinding had been uninsured after they sought care at a well being middle through the first six months of unwinding. Amongst these with the very best Medicaid disenrollment charges had been sufferers with HIV/AIDS, psychological well being situations, or SUDs. Whereas Congress just lately reauthorized elevated federal grant funding for well being facilities by 2024, the rise could not absolutely offset any drop in Medicaid income through the unwinding. The expiration of pandemic-related funding might additional stress well being middle funds.
Well being Middle Sufferers
The variety of sufferers served by served by well being facilities elevated in 2022, though the variety of youngster sufferers has not absolutely rebounded to pre-pandemic ranges. Following non permanent web site closures and social distancing steerage in the beginning of the coronavirus pandemic in 2020, the variety of sufferers dipped, however in 2021, the variety of sufferers started rising once more and that pattern continued in 2022. Well being facilities served 30.5 million sufferers in 2022, a rise of two% from 2019 (Determine 1). Though the variety of grownup sufferers elevated, the variety of youngster sufferers decreased by 4% and stays under the variety of youngsters served in 2019.
Well being facilities served fewer youngsters ages 5 and underneath in 2022 in comparison with 2019, driving the general drop in pediatric sufferers. From 2019 to 2022, the variety of youngsters 0-5 visiting well being facilities decreased 14% from 3.2 million to 2.7 million (Determine 1). The biggest decline within the 0-5 age vary was amongst youngsters underneath age 1, which declined from 688,000 sufferers in 2019 to 471,000 in 2022 (a 32% drop). There was a smaller lower within the variety of sufferers ages 6-11 (3%), whereas youngsters ages 12 and over noticed a 5% enhance over pre-pandemic affected person numbers.
Most well being middle sufferers had been folks of coloration, and the overwhelming majority had been low-income. In 2022, folks of coloration represented 63% of well being middle sufferers and Hispanic sufferers comprised the most important share of sufferers at 39% (Determine 3). Well being facilities additionally served many sufferers with restricted English proficiency, with roughly one in 4 sufferers (26%) who had been greatest served in a language aside from English. Reflecting their position as safety-net suppliers, 9 in ten well being middle sufferers had incomes that had been at or under 200% of the federal poverty stage (FPL) and two-thirds (66%) had incomes at or under 100% FPL in 2022 (Determine 3).
Well being Middle Companies
Whilst well being middle sufferers returned to in-person care in 2022, reliance on telehealth continued. Well being facilities supplied a complete of 126.9 million visits in 2022, together with 21 million telehealth visits (Determine 4). Telehealth visits represented 17% of whole visits, a considerably bigger share than the 2019 baseline of lower than 1%, however down from the excessive of 25% through the peak of the pandemic in 2020. Whereas in-person visits elevated relative to 2020, they remained under pre-pandemic ranges.
Psychological well being, substance use dysfunction (SUD), and medical companies drove development in well being middle visits from 2019 to 2022, whereas visits for dental and imaginative and prescient companies remained under pre-pandemic ranges. Total, well being middle visits had been 3% larger in 2022 in comparison with 2019. Visits for psychological well being and SUD companies elevated by 21%, with extra modest development in enabling companies (9%) and medical companies (4%) (Determine 5). Companies that had been largely supplied in individual, specifically imaginative and prescient and dental, declined by 3% and 17%, respectively, over the identical interval.
In step with the rise in psychological well being and SUD visits, the variety of well being middle sufferers identified with sure psychological well being and SUD problems elevated in 2022. In comparison with 2019, there was a notable enhance within the variety of sufferers experiencing anxiousness problems (26%) and a spotlight deficit and habits problems (21%) in 2022 (Determine 6). As well as, the variety of sufferers receiving medication-assisted remedy (MAT) for opioid use dysfunction elevated 36% from 2019.
Well being Middle Income Sources
The share of well being middle sufferers who had been uninsured continued to say no whereas the share enrolled in Medicaid surpassed 50%. From 2019 to 2022, the share of uninsured sufferers dropped 4 share factors from 23% to 19% whereas the share of Medicaid sufferers elevated from 49% to 51%, additional solidifying Medicaid as the most important supply of protection for sufferers (Determine 7). Each of those adjustments are largely attributable to the Medicaid steady enrollment provision, which briefly halted Medicaid disenrollments from March 2020 by March 2023. After March 2023, states resumed disenrollments as a part of the Medicaid unwinding.
Medicaid continued to be the most important supply of well being middle income, although federal grants and COVID-related funding had been additionally vital income sources in 2022. Medicaid accounted for 42% of well being middle income in 2022 whereas federal Part 330 grant funding, which helps well being facilities position as security web suppliers, made up 12% of revenues at well being facilities nationally (Determine 8). Moreover, pandemic-related funding made up 8% of all well being facilities’ income in 2022 though this funding has since expired. Well being middle revenues elevated by over $11 billion since 2019, primarily as a result of development in Medicaid funding associated to the rise in Medicaid sufferers and COVID-related funding.
