Health Care Access

The Community and Migrant Health Center program and the National Health Service Corps, administered by the federal Health Resources and Services Administration (HRSA), are designed, respectively, to increase the availability of primary and preventive health care services for low-income people living in medically underserved areas and to offer scholarships and educational loan repayments for health care professionals, some of whom, in turn, agree to work in these centers. GAO found that HRSA could increase the centers' effectiveness by establishing a systematic best practices program for their learning and by improving the completeness and accuracy of the data its uses to monitor them. Also, the Health Care Financing Administration could help ensure the centers' ability to continue serving Medicaid beneficiaries and uninsured persons by monitoring state Medicaid programs' compliance with federal requirements for reimbursing the centers. Shifting resources would help provide more National Health Service Corps loan repayments, and a better system is needed for identifying and measuring where health care professional placements are needed.

GAO noted that: (1) both the health centers and the Corps are important safety-net providers to the nation's vulnerable populations, but GAO believes certain improvements would enhance the effectiveness of these programs; (2) most health centers continue to be able to serve vulnerable populations, even though a number of significant changes have occurred in the health care environment; (3) HRSA has helped centers respond to developments such as the growing number of uninsured and Medicaid's increased use of managed care by encouraging centers to form networks and participate in managed care; (4) HRSA could increase its effectiveness, however, by establishing a systematic "best practices" program to allow centers to learn from one another and by improving the completeness and accuracy of its data--especially financial--that are used to monitor centers; (5) the Health Care Financing Administration, which administers the Medicaid program, could help ensure health centers' continued ability to serve Medicaid beneficiaries and the uninsured by monitoring state Medicaid programs' compliance with federal requirements for reimbursing centers; (6) since its reauthorization in 1990, the Corps has expanded and now provides thousands of health care providers to underserved areas; (7) however, it, too, could be more effective; (8) a shift of resources could help to provide more loan repayments; and (9) also needed are an improved system to identify and measure areas' need for Corps providers, a better placement process, and coordination with other federal and state efforts to place providers in areas that need them.