Federally Qualified Health Centers (FQHCs), Look-Alikes (LALs), and Rural Health Centers (RHCs) are important components of the health care safety net that serves California’s uninsured and Medi-Cal enrollees. Annual reporting indicates that FQHCs and these related health centers provided services to over 5.5 million Californians in 2019, at least 65% of whom were Medi-Cal enrollees.

However, limitations on utilization data by payer source make it difficult to assess specifically what percentage of primary care visits for the Medi-Cal population are provided by FQHCs, LALs, and RHCs. This report provides such an estimate in order to enhance understanding of the role that these organizations play in meeting the primary care needs of the state’s Medi-Cal population.

Key Findings:

• FQHCs, LALs, and RHCs delivered 43.7% of all primary care visits provided to Medi-Cal enrollees from October 1, 2017, through December 21, 2019. Moreover, there was a small but steady increase in the percentage of Medi-Cal primary care visits attributable to those clinics, from a low of 42.9% in the last quarter of 2017 to a high of 45.1% in the second quarter of 2019.
• These clinics provide a substantial percentage of primary care Medi-Cal visits regardless of race or ethnicity, with White and Latino/x enrollees having the highest utilization. The percentage of primary care visits attributable to these clinics was highest for those identifying as Other, White, or Latino/x (46.3%, 45.3%, and 45.2%, respectively).
• The percentage of primary care visits attributable to these clinics is highest in the North Coast / Far North and Central Valley market regions. It’s lowest in the Southern California region and in Los Angeles County. The Central Valley region had 7,686,592 visits attributable to FQHCs, LALs, and RHCs (55.2% of all Medi-Cal primary care visits). The two largest regional markets, represented by the metropolitan Southern California region (excluding Los Angeles) and Los Angeles County itself, have the lowest percentages of primary care visits attributed to FQHCs, LALs, and RHCs (33.5% and 30.4%, respectively).
• Populations identifying as Latino/x and those identifying as American Indian / Alaska Native have the highest and lowest overall utilization, respectively, across all regions. People identifying as Latino/x had 36.8 million primary care Medi-Cal visits, with 16.7 million visits attributable to FQHCs, LALs, and RHCs. Conversely, those identifying as American Indian / Alaska Native (AIAN) had the lowest numbers of primary care visits overall and in FQHCs, LALs, and RHCs, most likely due to the more common utilization of Indian Health Services (IHS) or IHS-contracted clinics.
• There is significant variation in primary care visit attribution by Medi-Cal aid code. The percentage of primary care visits attributable to FQHCs, LALs, and RHCs varies from a low of 33.3% for people in the “Adoption Assistance” aid code group, to a high of 84.9% for people in the “Other_1” aid code group. The “Other_1” group includes enrollees who qualify as medically indigent adults, for refugee resettlement or minor consent services, and codes for those impacted by human trafficking, along with other smaller categories.

While these data support the conclusion that FQHCs, LALs, and RHCs make an indispensable contribution to providing comprehensive primary care services to Medi-Cal enrollees, a broader finding relates to the difficulty and complexity in undertaking this analysis to answer a relatively straightforward research question. Fortunately, federal and state initiatives are trying to improve the accessibility and usability of basic claims and encounter data in Medi-Cal. Ready access to more comprehensive and timely utilization data would facilitate the answers to even more actionable questions.

About the Authors

Helen DuPlessis is a physician executive and principal at Health Management Associates with deep expertise in public sector health systems and programs, practice transformation, maternal and child health programs and policy development, substance use disorder, and performance improvement. She has worked in and supported redesigns of many sectors in the broader health system, including Federally Qualified Health Centers, managed care organizations, local health jurisdictions, and communities.

Mary Goddeeris is a health economist and finance expert at Health Management Associates whose work has centered on hospital and Medicaid financing. She has more than 12 years of experience working with health systems providers on financial analysis, modeling, and health system assessments.