Funding uncertainty has always been part of the FQHC landscape. Over decades of working with health centers across the country, we’ve seen funding cycles rise and fall — often with little warning and even less clarity.
What determines whether a health center weathers those shifts isn’t the headlines themselves. It’s the business model underneath them.
At FQHC Associates, we’ve long believed that sustainability is built internally — through leadership decisions, revenue strategy, and financial structure — not externally through policy certainty. That perspective is reinforced by a recent podcast conversation we’re sharing below, which offers a real-world example of what this looks like in practice.
Listen to the Podcast (Related Conversation) 🎧
Stop Waiting for Funding Certainty: The Business Model Shift You Need for 2026
This podcast features Jill Steeley, a former FQHC CEO who led a major financial turnaround at PureView Health Center. Her experience provides concrete context for challenges we see repeatedly across the field — particularly around grant dependency and long-term financial resilience.
👉 Listen to the full episode (or, if you prefer, listen on Spotify)
Why Funding Uncertainty Has Always Been Part of the FQHC Landscape
Anyone who has spent time leading or advising a health center knows this reality: uncertainty is not an anomaly in this sector — it’s a constant.
Funding cycles shift. Priorities change. Policy clarity comes and goes. Yet many organizations continue to operate as if stability will arrive at some future point, and planning can begin then.
The challenge is that waiting for certainty often delays the very decisions that would make a health center more resilient.
Financial Sustainability Is an Internal Issue, Not a Policy Problem
One pattern we’ve consistently seen is the assumption that financial strain is driven primarily by external forces beyond a health center’s control.
In reality, many health centers have built their entire operating models around systems that were never designed to provide long-term sustainability. When instability appears — as it inevitably does — those models leave little room to adapt.
As discussed in the podcast:
“The real problem isn’t funding instability itself. The real problem is that we have built our health centers and our entire business models on a system that was never meant to keep us sustainable.”
That framing matters. It shifts the conversation away from reacting to external events and toward examining internal structure — which is where leadership teams actually have influence.
Why Grant Dependency Isn’t the Root Problem
Grant funding plays an important role in the safety net. The issue isn’t that grants exist — it’s how central they become to an organization’s survival.
When a health center’s underlying business model is built on the assumption that grants will always be required to close the gap, dependency becomes the outcome. Over time, the organization adapts to manage scarcity rather than build margin, flexibility, and long-term resilience.
In that sense, grant dependency is a symptom of a deeper structural issue — not the root cause itself.
Three Business Model Patterns That Keep Health Centers Stuck
Across the health centers we work with, three patterns appear again and again — and they are reinforced in the podcast conversation as well.
1. Treating Grant Dependency as Inevitable
Somewhere along the way, many health centers accepted the idea that serving underserved populations requires permanent financial fragility. That belief constrains strategic thinking and narrows what leaders believe is possible.
2. Managing Symptoms Instead of Fixing the Revenue Model
When pressure mounts, organizations often respond by freezing hiring, delaying investments, or cutting programs. These actions may buy time, but they don’t address the underlying revenue model — keeping centers in a cycle of crisis management.
3. Operating in Silos Instead of Learning from Peers
Too many leadership teams are solving the same problems independently. Operating in isolation wastes time, resources, and momentum — especially when proven approaches already exist elsewhere in the field.
A Real-World Example of Financial Resilience
The podcast discussion includes the experience of PureView Health Center during one of its most difficult periods: a million-dollar deficit, negative press about layoffs, five years without recruiting a medical doctor, and a 12-month ultimatum from the board.
Through deliberate changes to the organization’s revenue model, leadership approach, and assumptions about what was possible, the health center reduced its federal funding dependency from 62.5% to 17% — while serving more uninsured patients, expanding services, and building financial reserves.
This outcome wasn’t the result of waiting for policy stability. It came from rethinking the foundation the organization was built on.
Why Financial Sustainability Is Essential to the FQHC Mission
One reminder worth repeating:
“No margin, no mission. If we don’t have the doors open, we can’t serve anyone.”
Financial sustainability and mission impact are not competing goals. In practice, they are inseparable. Without margin, flexibility disappears. Without flexibility, leaders are forced into reactive decisions that can undermine long-term access and care.
Why This Conversation Matters for FQHC Leaders Right Now
Periods of heightened uncertainty tend to expose structural realities that already exist. Health centers with diversified revenue, operational flexibility, and financial margin can respond thoughtfully. Those without them are often forced into decisions under pressure.
The value of this conversation — and the podcast that illustrates it — isn’t that it offers a checklist or quick fix. It’s that it encourages leaders to step back and ask harder, more foundational questions before circumstances make those questions unavoidable.
If you’re thinking seriously about what sustainability looks like for your organization in 2026 and beyond, this is a worthwhile place to start.
Listen: Stop Waiting for Funding Certainty
👉 Listen to the podcast episode: Stop Waiting for Funding Certainty: The Business Model Shift You Need for 2026 (or, if you prefer, listen on Spotify)
At FQHC Associates, we’ve long believed that financial sustainability is not separate from mission — it’s what makes the mission possible. Conversations like this help move the field toward models that allow both to thrive.
About the Author
Steven D. Weinman, MBA, Principal at FQHC Associates
During his time as a management and IT consultant for Coopers & Lybrand (now PwC), Steve became proficient in designing and programming complex business software systems. In 1984 he was recruited by a small Community Health Center (CHC) in Southwest Florida to revive it’s failed first attempt at automation. After creating and implementing a Practice Management (PM) system, he advanced from IT director to CFO, where he grew the $3 million, single site FQHC into a more than $30 million program. When Mr. Weinman retired in 2013 to devote his full time to a growing consultancy, he was serving as Executive VP/COO with over 300 employees (all except the CEO), 13 sites, a Ronald McDonald Care Mobile, a dental residency program and a wholly owned Medicaid Health Plan.
In addition to his employment, Mr. Weinman has been actively involved in the national CHC movement since 1988. He brings extensive experience in board training, strategic planning, IT, grant writing, staff development and a host of other services to CHCs and Primary Care Associations (PCAs) across the country. As a noted expert in topics including finance, operations, managed care, IT and governance, Mr. Weinman is in great demand as a speaker at national CHC and state PCA conferences. In addition, he has authored numerous articles, issue briefs and blog posts. Mr. Weinman is particularly well known for his work with FQHC Medicare/Medicaid policy and strategy, the 340B Drug Program and development of FQHC focused integrated delivery systems.
To read blog posts by Steven, click here.
To contact Steven, send him an email at SDWeinman@FQHC.org.
