Upper Great Lakes Family Health Centers

In early 2014 Portage Health announced a unique partnership with Upper Great Lakes Family Health Center that involved transitioning all Portage Health Primary Care Practices to Family Health Centers. This partnership is made possible by funding received from the Federal Bureau of Primary Health Care.

The change to Family Health Centers will not have any effect on established patients, who will continue to see their provider just as they did before. It does open up an opportunity for low-income patients, who will be able to pay on a sliding fee based on federal poverty guidelines. This also allows Portage Health to continue seeing Medicare patients at the health centers.

Below are a list of frequently asked questions about Upper Great Lakes Family Health Center, Federal Qualified Health Centers and Family Health Centers. If you have additional questions, e-mail UGLFHC Chief Executive Officer Don Simila at info@uglhealth.org.

Frequently Asked Questions (FAQs) about Federally Qualified Health Centers

Q: What is Upper Great Lakes Family Health Centers? 

A: Upper Great Lakes Family Health Center (UGLFHC) is a not-for-profit organization that operates Federally Qualified Health Clinics (FQHCs) in Gwinn, Sawyer and Houghton. The organization exists to meet the rising need for affordable, accessible healthcare. UGLFHC operates to expand access for everyone, with special attention to underinsured populations. 

Q: What is a Federally Qualified Health Center?

A: Federally Qualified Health Centers include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding-fee scale, provide comprehensive services, have an ongoing quality assurance program and have a governing board of directors. Certain tribal organizations and FQHC Look-Alikes (an organization that meets PHS Section 330 eligibility requirements, but does not receive grant funding) also may receive special Medicare and Medicaid reimbursement.

Q: Are the FQHCs a service of Portage Health? 

A: The FQHCs are completely separate entities from Portage Health with a Board of Directors, at least 51% consumers, who will receive their care from the FQHC. Portage Health and Upper Great Lakes Family Health Center are in a supportive partnership. Portage Health has no intention of controlling Upper Great Lakes Family Health Center. An FQHC is an independent organization and cannot, by regulation, be controlled by a hospital. 

Q: Why are you opening FQHCs in Houghton County?

A: There are many residents throughout the Upper Peninsula who are underinsured, and a clinic with an FQHC designation can help serve the underserved population while maintaining stable healthcare in the communities. 

Q: What other differences are there between FQHCs and Rural Health Clinics? 

A: Federally Qualified Health Clinics (FQHCs) and Rural Health Clinics (RHCs) have a different designation with different requirements and benefits. There are differences in staffing requirements, services provided, corporate structure and other features. For example RHCs must have midlevel practitioners; FQHCs do not have this requirement. FQHCs must be not-for-profit and have a community-based Board of Directors; RHCs do not require a Board of Directors. FQHCs need to offer a broader range of services including dental and behavioral health; RHCs do not. FQHCs have the 340B drug program. RHCs do not.

The Rural Assistance Center at www.raconline.org is a good reference for more information on the differences.

Below is a comparison chart between FQHCs, RHCs, and Critical Access Hospitals (CAHs).

Comparison Chart
Benefits/Issue	RHC	FQHC	CAH
Shortage area location	Located in HPSA* or MUA**	Serve MUA/MUP***	N/A
Access to base grant	No	Yes	No
Access to 340B Federal Drug Pricing	No	Yes	No
FTCA malpractice insurance coverage	No	Grantees only	N/A
Sliding-fees required	No	Yes	Charity care
Support for other services (e.g. mental health, dental, specialty services)	Some, but not dental	Yes	Limited
Corporate status	Any	Not-for-profit	Any

* HPSA - Health Professional Shortage Area
** MUA - Medically Underserved Area
*** MUP - Medically Underserved Population

A: There are 32 health center organizations (FQHCs), and three FQHC-Look Alike organizations. Several of the 32 organizations have multiple sites.Q: How many FQHC are there in Michigan?

Q: Who runs and makes decisions about UGLFHC?

A: A volunteer Board of Directors makes the decisions for the Upper Great Lakes Family Health Center. The Board is composed of individuals from Houghton, Keweenaw and Marquette counties. At least 51% of the board is FQHC consumers.
The UGLFHC Chief Executive Officer (CEO) is Don Simila. Each location also has a manager.

Q: Is the FQHC program a new initiative from the Federal government?

A: The FQHC program has been around since the 1960’s. More recently the program has experienced increased funding. The federal legislators are watching this program and consider it as one of the positive factors in healthcare reform. They are doing their due diligence with programs and the currently funded programs are being held to high standards.

Q: Is the FQHC program growing rapidly?

A: Yes. Currently, there are slightly more than 1,200 FQHC organizations nationally. Many organizations have multiple sites. The FQHC program expanded very rapidly under the George W. Bush administration, and the program continues to grow under the Obama administration. There is every indication that the program will continue to grow in the years to come.

Q: Are there restrictions on where an FQHC is located?

A: An FQHC must be located in a federally designated Underserved Area, or serve an Underserved Population. To be fiscally responsible, an FQHC needs to determine the number of un/underserved individuals in a reasonable service area – a general but not absolute number is 5,000 un/underserved individuals. A new FQHC usually increases to a base of 5,000 over a three-year period.

Q: Is there an entrance fee or admittance fee?

A: No. However, an FQHC is not a free clinic. There is an absolute expectation that people will pay according to a sliding-fee (based on annual federal poverty guidelines).

Q: Are there co-pays?

A: There are no Medicaid co-payments. There are co-payments for many third-party insurances and for Medicare.

Q: Do FQHCs cover optical services?

A: For screening, yes. Other services, no. However, most FQHC staff work diligently to arrange for needed care (on a sliding-fee) for all their patients.

Q: Does an FQHC provide services to children?

A: Yes, an FQHC must offer services to all ages. An FQHC patient profile varies and reflects community need. The largest cohort of underinsured includes people from 19 – 64 years of age (those usually not eligible for Medicaid/Medicare).

Q: How does reimbursement work for patients who are referred for specialty care?

A: An FQHC grant provides funding for primary care, oral healthcare, and behavioral health/substance abuse counseling services. FQHCs traditionally work with specialists to arrange for services on a sliding-fee scale. Specialty care access is a significant challenge for FQHCs, and each community develops its own strategies or models to providing specialty care services. There is no one all-inclusive solution.

Q: What happens when a patient of an FQHC has to go to the hospital?

A: An FQHC is required to have an arrangement for inpatient services, available on a sliding-fee, for patients that need inpatient care.