Medicaid Policy Leadership

Medicaid is the foundation of America's health care safety net

And Community Health Centers make every Medicaid dollar go further

Advocates for Community Health (ACH) is leading federal policy efforts to protect, strengthen, and modernize Medicaid so health centers can continue delivering high-quality, cost-effective care in communities across the country.

With H.R.1 implementation underway, now the focus must shift from policy change to real-world impact—and what comes next.

Medicaid Impact

32M+

Patients served by CHCs in 2024

50%+

CHC patients are covered by Medicaid

45%

of $49.8 billion in total CHC revenue was from Medicaid in 2024

$35 Billion

Estimated impact of revenue loss to CHCs as a result of H.R. 1

Why Medicaid Matters

Medicaid remains one of the most powerful tools we have to improve health outcomes, reduce costs, and strengthen local economies.

It is vitally important source of revenue for community health centers allowing predictability and solvency
It enables access to care for rural, underserved, and working families
It prevents more costly care like visits to emergency rooms by investing in primary and preventive services

When Medicaid is weakened, patients delay or forgo care, conditions worsen, and costs rise across the system.

Medicaid's Rural Impact

Health centers are the critical primary care bridge for millions of rural Americans. Serving nearly 1 in 3 rural Americans, health centers are often the only care provider for miles and their patients often present with complex health scenarios, tending to older, sicker, and often overlooked.

Nearly 1 in 4 rural residents rely on Medicaid for essential care
Over 50% of rural Medicaid enrollees are children and expansion adults
Nearly 40% of rural Medicaid enrollees under age 65 have a diagnosed chronic condition

The Rural Health Transformation Program was created as part of H.R. 1 to provide $50 billion over five years to support rural providers. However, the same legislation also includes Medicaid reductions estimated at $137 billion over the next decade. This reveals a core contradiction: policymakers are changing Medicaid, the primary payer for rural and safety-net care, while expecting rural systems to transform, without addressing the impact the Medicaid changes are expected to have on providers in rural and underserved communities.

The Case for Community Health Centers

Recent federal Medicaid policy changes are already impacting patients, providers, and communities nationwide and placing new strain on the health care safety net.

At the same time, community health centers are model stewards of federal investment, delivering better outcomes at lower cost.

Health centers reduce federal spending by lowering reliance on emergency and hospital care
For Medicaid patients, care at health centers is significantly more cost-effective than other settings
Research shows that for every $1 invested in primary care, like the care provided at health centers, $13 is saved in downstream costs through the prevention of expensive complications and emergency room visits

As changes to Medicaid increase, health centers will endure added financial pressure as the number of patients categorized as uncompensated care continues to rise. Investing in community health centers becomes even more critical. Every dollar directed toward primary care through health centers strengthens access, improves outcomes, and reduces long-term system costs.

As these pressures increase, community health centers are not just part of the system, they are the solution.

The ACH Medicaid Policy Framework

1. Protect Stability & Ensure CHCs are at The Table

Medicaid must remain a strong, reliable foundation for community health centers and the patients they serve. When implementing H.R. 1, CMS and states must account for the role CHCs play in serving high-need populations and maintaining access to care in rural and underserved communities.

Oppose broad, destabilizing policy changes
Ensure sustainable, long-term funding
Maintain predictable reimbursement structures

2. Preserve Access to Primary Care & Chronic Disease Management

Medicaid is essential to rural and underserved communities, and chronic disease management.

Congress should identify alternative sources of funding for these services as they are foundational to care.
Protect access in rural and high-need areas
Strengthen community-based care delivery

3. Strengthen Primary Care Investment

Federal policy should prioritize cost-effective care that improves outcomes.

Invest in primary and preventive care
Support payment models that reflect value, not volume
Support workforce and infrastructure needs

ACH Medicaid Policy Impact

ACH is driving national Medicaid policy conversations and advancing solutions that reflect real-world impact.

Leading national advocacy efforts to protect Medicaid funding and Rural Health Transformation Program efforts for health centers
Organizing coalition letters and engaging Congress directly
Elevating the role of community health centers in federal policy decisions
Supporting our members with tools and resources for H.R. 1 implementation

Our advocacy translates into real resources, real access, and real care for millions of patients.

ACH Highlights:

Advocacy

In the Media

Outreach

About ACH

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