Becoming an FQHC – Is it Right for Your Organization?

Here at FQHC Germane, we get many inquiries about starting or becoming a Federally Qualified Health Center (FQHC). FQHCs, are also referred to as “Community Health Centers” (CHCs) or sometimes just “Health Centers” (although not all health centers are CHCs/FQHCs). We hear from a wide range of individuals and organizations, but most inquiries come from existing health care organizations who see the benefits in transitioning to an FQHC model of care, both to the community-at-large and to the organization itself.

When receiving these inquiries, our first step is generally to make sure that the individual or organization understands everything that becoming an FQHC entails. Often, after we send information about program requirements, the inquirer decides not to pursue FQHC status. This is understandable, because the process of becoming an FQHC is a major undertaking, and it’s important to understand both what an FQHC is and whether or not this model of care is right for your organization.

Let’s start with some basic info on how to become an FQHC. An organization can only become an FQHC when the Health Resources and Services Administration (HRSA) issues an appropriate funding opportunity. These can be either a competitive grant for an existing service area, or an opportunity to apply for a new access point. These grant opportunities and application deadlines can be found here. An eligible organization can also apply to become an FQHC Look-Alike, which is similar to an FQHC in that it has to meet the same program requirements and will receive many of the same benefits. However, a Look-Alike receives no funding from HRSA, and there is no deadline to apply for Look-Alike status. More information on Look-Alikes can be found here.

Next, let’s talk about who health centers (FQHCs and Look-Alikes) serve. Health centers are required to serve everyone, regardless of ability to pay, insurance status, immigration status, etc. Furthermore, each health center must serve at least one Medically Underserved Area (MUA) or Medically Underserved Population (MUP). The guidelines used to determine MUAs/MUPs include primary care physician to population ratio, infant mortality rate, percentage of population living below poverty level, and population aged 65 and over.

Another significant consideration are the 19 FQHC program requirements . Many of the individuals and organizations that contact us don’t realize how extensive these requirements are. For example, “health centers must provide all required primary, preventive, enabling health services and additional health services as appropriate and necessary, either directly or through established written arrangements and referrals.” These required services include primary care, prenatal/perinatal services, preventive dental, family planning, a host of screenings, lab/radiology services, emergency medical services, case management, and access to language interpretation (this not a comprehensive list).

Many of the requirements dictate  how the Health Center must be governed. In addition to mandating a patient majority on the board of directors, there are numerous other requirements focusing on board demographics, expertise and behaviors.  Beyond governance, there are requirements related to:

  • community need
  • staffing
  • hours of operation
  • site location(s)
  • after hours coverage
  • sliding fee discounts
  • quality improvement/assurance
  • management staff
  • contractual/affiliation agreements
  • collaborative relationships
  • financial management and control
  • billing and collections
  • budgets  
  • data reporting systems
  • project scope
  • conflicts of interest

Now that you’re somewhat familiar with the health center program, you’ll want to take a look inward at your organization, and outward at the community to be served. You should conduct an internal assessment of organizational structure, operating environment, and key community relationships. Then, you will generally want to conduct a Community Needs Assessment, focusing on the key HRSA-identified factors. 

Since you are still reading this, you should have a better idea of whether pursuing FQHC or Look-Alike status may be right for your organization. Rather than a complete guide to becoming an FQHC or Look-Alike, this post should be considered a brief overview of many of the challenges involved in becoming part of the health center movement. For more information about this topic, or anything else FQHC-related, please feel free to contact FQHC Germane. Our team has decades of experience in the FQHC arena, as well as many aspects of the US healthcare system.

Visit www.FQHC.org for more information about Our Services, the FQHC Germane team and the latest FQHC-related news.


Jennifer Garces de Marcilla is a Project Manager at FQHC Germane, a health care consulting firm specializing in the needs of established, new and potential Federally Qualified Health Centers (FQHCs).

Read more about Jennifer here.

To contact Jennifer, email her at jweinman@fqhc.org.