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Federal Aid Strengthens Health Care Safety Net

Communities with Well-Established Safety Nets Benefit the Most

News Releases
April 22, 2004

Alwyn Cassil: (202) 264-3484

ASHINGTON, D.C.—An infusion of federal funding has helped many communities expand services and strengthen linkages among health care safety net providers, according to a study released today by the Center for Studying Health System Change (HSC).

Two federal initiatives—community health center (CHC) expansion and Community Access Program (CAP) grants—have improved access to care for low-income people and increased coordination among CHCs and other safety net providers, especially hospitals, the study found. However, communities with weaker safety nets were less likely to receive federal aid.

"To some degree, communities with strong safety nets were in a better position to win grants—it’s a case of the strong getting stronger," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

The study’s findings are detailed in a new HSC Issue BriefFederal Aid Strengthens Health Care Safety Net: The Strong Get Stronger. The study by John F. Hoadley, an HSC consulting researcher from Georgetown University, HSC Research Analyst Laurie E. Felland and HSC Research Assistant Andrea Staiti is based on HSC’s 2002-03 site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.

Ten of the 12 HSC communities—except Little Rock and Syracuse—received CHC expansion and/or CAP grants. CHC expansion grants focus on adding preventive and primary care services at new or existing health centers, with a goal of increasing the number of patients treated annually at CHCs from about 10 million in 2001 to more than 16 million in 2006. CAP grants are designed to enhance collaboration among safety net providers and improve coordination of existing inpatient and outpatient care for uninsured and underinsured people.

Other key study findings include:

  • Both grant programs have a made a difference in communities successful in gaining the additional federal aid. But funding for both programs is limited, hampering the potential impact on the nation’s system of care for low-income and uninsured people.
  • Generally, communities with stronger existing safety nets tended to be more successful in obtaining grants, while communities with less well-established safety nets have not reaped as much benefit. For example, communities such as Boston with relatively large safety net capacity appeared more likely to receive expansion and CAP grants than communities with smaller, struggling safety nets such as Little Rock.
  • A number of factors contributed to the overall pattern of communities with stronger safety nets gaining greater federal aid, including strong CHC management infrastructure, leadership and financial viability. One possible way to address these community-level disparities would be to provide technical assistance to help communities with struggling safety nets successfully obtain grants.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.