Rigid grant funding undermines community health centers’ ability to serve vulnerable New Yorkers

Community health centers (CHCs), a cornerstone of New York City’s health care safety net, are being hamstrung by inflexible grant funding structures that limit their ability to provide comprehensive, equitable care, according to a new study by Columbia University Mailman School of Public Health researchers published in BMC Health Services Research.

CHCs serve one in nine New York State residents, many of whom have complex health and social needs. Yet despite their critical role, these centers operate on razor-thin margins, with 21% of their revenue tied to restrictive state and local grants.

Through interviews with 56 CHC leaders and staff in New York City, researchers identified three major barriers:

1. Overly Narrow Funding: Grants are often restricted to specific conditions (e.g., HIV, diabetes) or populations (e.g., children, the elderly), limiting CHCs’ ability to address broader community health needs and preventive care.
2. Chronic Underfunding of Operations: Critical needs like facility maintenance and administrative support are frequently excluded from grants, impeding CHCs’ ability to sustain—let alone expand—services.
3. Workforce Shortfalls: Funding limitations prevent CHCs from hiring sufficient staff—particularly key roles like care coordinators and patient navigators—leading to uneven care quality across patient groups.

These constraints compromise CHCs’ ability to innovate and meet the full spectrum of community needs, according to the researchers.

“As policymakers consider budget allocations amid potential Medicaid cuts and broader austerity measures, our study underscores the critical need for more flexible, general operating support for CHCs,” says the study’s co-senior author, Thalia Porteny, Ph.D., assistant professor of health policy and management at Columbia Mailman. “Condition-specific grant funding fails to accommodate the holistic care approaches necessary for addressing complex health and social needs in underserved populations.”

Co-senior author Sorcha A. Brophy, Ph.D., also an assistant professor at Columbia Mailman, warns: “Without adjustments to funding structures, CHCs risk further financial instability, reduced service capacity, and exacerbation of health disparities.”

“CHCs are a key pillar of the health care safety net. More flexible funding is critical to sustaining CHCs, whereas current funding structures undermine their ability to provide quality care and reduce health inequities in their communities,” says study first author Emily Burroughs, a former Columbia Mailman research associate.

The study builds on earlier research by Brophy and Porteny, which found that low Medicaid telehealth reimbursements are worsening workforce shortages at New York’s Federally Qualified Health Centers (FQHCs), particularly in mental health care.

Community health centers (CHCs), a cornerstone of New York City’s health care safety net, are being hamstrung by inflexible grant funding structures that limit their ability to provide comprehensive, equitable care, according to a new study by Columbia University Mailman School of Public Health researchers published in BMC Health Services Research.

CHCs serve one in nine New York State residents, many of whom have complex health and social needs. Yet despite their critical role, these centers operate on razor-thin margins, with 21% of their revenue tied to restrictive state and local grants.

Through interviews with 56 CHC leaders and staff in New York City, researchers identified three major barriers:

1. Overly Narrow Funding: Grants are often restricted to specific conditions (e.g., HIV, diabetes) or populations (e.g., children, the elderly), limiting CHCs’ ability to address broader community health needs and preventive care.
2. Chronic Underfunding of Operations: Critical needs like facility maintenance and administrative support are frequently excluded from grants, impeding CHCs’ ability to sustain—let alone expand—services.
3. Workforce Shortfalls: Funding limitations prevent CHCs from hiring sufficient staff—particularly key roles like care coordinators and patient navigators—leading to uneven care quality across patient groups.

These constraints compromise CHCs’ ability to innovate and meet the full spectrum of community needs, according to the researchers.

“As policymakers consider budget allocations amid potential Medicaid cuts and broader austerity measures, our study underscores the critical need for more flexible, general operating support for CHCs,” says the study’s co-senior author, Thalia Porteny, Ph.D., assistant professor of health policy and management at Columbia Mailman. “Condition-specific grant funding fails to accommodate the holistic care approaches necessary for addressing complex health and social needs in underserved populations.”

Co-senior author Sorcha A. Brophy, Ph.D., also an assistant professor at Columbia Mailman, warns: “Without adjustments to funding structures, CHCs risk further financial instability, reduced service capacity, and exacerbation of health disparities.”

“CHCs are a key pillar of the health care safety net. More flexible funding is critical to sustaining CHCs, whereas current funding structures undermine their ability to provide quality care and reduce health inequities in their communities,” says study first author Emily Burroughs, a former Columbia Mailman research associate.

The study builds on earlier research by Brophy and Porteny, which found that low Medicaid telehealth reimbursements are worsening workforce shortages at New York’s Federally Qualified Health Centers (FQHCs), particularly in mental health care.