How insurance works at community health centers — and how to get enrolled if you don't have any.
No. FQHCs see uninsured patients through their sliding fee discount program. But having insurance — especially Medicaid — can significantly reduce your out-of-pocket costs.
FQHCs receive enhanced Medicaid reimbursement rates (FQHC PPS). If you have Medicaid, your copay at most FQHCs is $0–$3. FQHCs are among the best places to use Medicaid.
FQHCs accept Medicare Part B. Patients pay 20% of the Medicare-approved rate after the deductible, or less if they have supplemental coverage.
Children's Health Insurance Program covers children up to age 19. FQHCs accept CHIP and copays are minimal.
Most FQHCs accept private insurance. Check with the specific clinic to confirm your plan is in-network.
Uninsured patients use the sliding fee scale based on income. See the Cost & Payment guide for details.
Many FQHC patients qualify for Medicaid or CHIP but haven't enrolled. FQHCs are required to help patients apply — this service is free.
When you visit, ask for:
They can determine eligibility, complete the application on your behalf, and follow up with the state agency.
| Group | Income Limit (% FPL) | Notes |
|---|---|---|
| Children | Up to 200–300% | Varies by state; CHIP fills gap above Medicaid |
| Pregnant Women | Up to 138–200% | Most states cover prenatal + 60 days postpartum |
| Adults (expansion states) | Up to 138% | 40 states + DC have expanded Medicaid |
| Adults (non-expansion states) | Very limited | May not qualify without disability or pregnancy |
| Disabled / SSI recipients | Automatic | SSI receipt triggers Medicaid in most states |
Most FQHCs have enrollment staff on-site. Find one near you in our directory.
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