What Are FQHCs?: Immigrant's Guide to Community Health Centers
Federally Qualified Health Centers, or FQHCs, are community health clinics that offer medical care to underserved communities, particularly low-income and uninsured patients and Medicare and Medicaid recipients, though they are open to all people regardless of their ability to pay. FQHCs bill uninsured patients who pay out-of-pocket based on their income, meaning the less they earn, the less they pay—and sometimes their care is free. FQHCs provide care to almost 34 million Americans annually, with around 90% of their patients earning incomes below 200% of the federal poverty line (FPL). Their services are especially valuable to undocumented immigrants who are often uninsured and do not qualify for public health benefits like Medicare and Medicaid, and to rural communities lacking provider access.
FQHCs primarily receive their funding through federal grants and reimbursement from Medicare, Medicaid, and CHIP. To receive federal funds, they must adhere to federal guidelines for affordability, accessibility, and efficiency. Community health centers that meet the qualifications for federal funding but do not receive federal grants are called “FQHC look-alikes”.
Migrant Health Centers
Migrant Health Centers are FQHCs that provide culturally competent healthcare services explicitly tailored to the needs of migrant and seasonal farmworkers and their families. They promote accessibility with multilingual interpretation, after-hours care, transportation services, and mobile clinics. Like all FQHCs, Migrant Health Centers offer affordable comprehensive and preventative care with sliding-scale discounts. Around 83% of migrant farmworkers receive care through Migrant Health Centers.
Services
FQHCs provide comprehensive and preventative primary care, usually alongside dental and behavioral health services. They may also partner with hospitals, independent practitioners, and larger health systems to streamline patient access to emergency and specialty medical care, simplify information sharing and promote clinical continuity between providers, and improve patient outcomes.
Cost
FQHCs cannot refuse care because of a patient’s inability to pay. The prices of individual services are fixed and determined by the federal Health Resources and Services Administration (HRSA) through its Prospective Payment System (PPS), which is used by Medicaid agencies to reimburse FQHCs for the care they provide to Medicaid patients.The FQHC base rate is the national benchmark price for a single patient visit to an FQHC. It reflects the average cost for a health center to provide care for a patient on their visit. The current FQHC base rate is set at $202.65 for Fiscal Year 2025. This means that a FQHC visit will cost around $202.65, regardless of the treatment a patient receives, the resources and number of physicians and staff needed to care for a patient, or the amount of time spent caring for them.
PPS FQHC Base Rates (FY 2025)
However, the actual base rate charged for a visit will vary slightly by location as the HRSA makes adjustments on a regional basis to account for local income levels and the expected market cost to provide care. These adjustments are called Geographic Adjustment Factors (GAFs). New FQHC patients are charged the adjusted PPS rate plus an additional 34% for their initial visit.
Medicare, Medicaid, and CHIP
Medicare, Medicaid, and CHIP patients generally pay little to nothing for care at an FQHC. Some patients may be charged a co-pay depending on state regulations and the care they receive.
Private Insurance
Privately insured patients can also receive care at an FQHC, though they may still incur some out-of-pocket costs like co-pays, co-insurance, and deductibles.
Uninsured and underinsured
FQHCs decide the price of their services for uninsured and underinsured patients who pay out-of-pocket, though these must reasonably reflect the actual value of care provided and are based on the PPS FQHC rate. Patients paying out-of-pocket are charged according to a sliding-scale fee schedule. Sliding-scale fee schedules are used by FQHCs to determine how much a patient pays for their care based on calculations of their income level by household size, according to federal guidelines. Patients making less money and with larger households will pay less for their visit. Generally, patients with household incomes above 200% of the federal poverty line (FPL) pay full cost for their care. Those who earn below 100% FPL typically receive care for free or for a nominal charge. FQHCs must offer discounts to all patients earning less than or equal to 200% FPL and are required to inform all qualified patients of the sliding-scale discounts available to them. These pricing guidelines also apply to insured patients whose care is not covered by their insurer.
What to bring
On your initial visit to an FQHC, you will likely need to bring a few essential materials, including:
Identification (driver’s license, government-issued ID, passport)
Proof of address (utility bill, rental contract, mail addressed to you)
Insurance card
Payment method
You do not need a Social Security number (SSN) to receive care at an FQHC, though you may need to provide an SSN if enrolling in Medicaid or Marketplace health insurance.
If you are uninsured and paying out-of-pocket, you will need to provide proof of income to qualify for sliding-scale discounts. Documents proving your income include:
Recent pay stubs
Form W-2
Tax return
Letter of employment
Undocumented immigrants
FQHCs provide care to all patients regardless of their immigration status. They generally do not inquire about a patient’s immigration status, request immigration documentation, or track the immigration statuses of their patients. You do not have to answer any questions or provide any information about your immigration status. Undocumented individuals without American IDs sometimes present foreign IDs or other non-standard documents to prove their identity. Consult your FQHC about their policies and documentation requirements for undocumented patients.
In mid-July 2025, the US Department of Health and Human Services issued a notice updating agency policy to prohibit care for undocumented immigrants at FQHCs. However, its implications for health center practices remain uncertain as the notice did not provide any instructions for FQHCs to verify the immigration statuses of their patients. At the moment, FQHCs are continuing to care for undocumented immigrants.