Federally qualified health centers (FQHCs) are facing a worsening shortage of mental health clinicians while at the same time pushing to increase access to behavioral health services.

FQHCs provide primary care services to as many as 31 million Americans annually. However, 77% of FQHC leaders surveyed by the Commonwealth Fund report a shortage of mental health providers at their largest locations. That figure is up seven percentage points compared to 2018 . 

“Workforce shortages pose a significant barrier to providing timely access to care, and our survey reveals that shortages at community health centers have gotten significantly worse over time,” the report states. “There were no significant differences in shortages by geography in 2024.”

The report pointed to other research that attributes the general struggle to get clinical staff to work in FQHCs to competition from other better-financed health care organizations and the lingering impacts of the COVID-19 pandemic on the well-being of health care staff.

The shortage of providers is concerning for FQHCs twice over. On top of the shortage of mental health providers, FQHCs increasingly treat those with behavioral health issues.

“Today, behavioral health issues, including substance use and mental health disorders, are the most common conditions associated with visits to community health centers — more so than hypertension and obesity,” the report states.

The largest expansion of behavioral health-related services is in addiction treatment: 62% of FQHCs offer medication-assisted treatment (MAT) in 2024 compared to just 37% in 2018. Centers offering general substance use disorder treatment are also up to 66%, compared to 54%.

Telehealth usage has also increased significantly since 2018, likely driven by the pandemic and policymakers’ general response to enable greater use of telehealth as a preventative measure. In 2024, 96% of FQHCs offer telehealth. That figure was 24% in 2018. Significant numbers of FQHCs offer virtual behavioral health services: 88% offer virtual SUD treatment, while 70% offer virtual mental health counseling. The report does not include comparable data for 2018.

More FQHCs are reporting that they are partnering with other community organizations to meet social determinants of health, but few get updates from those partners about their mutually shared clients. Sixty-one percent of FQHCs partner with other organizations (up from 55%), but only 25% report that they “usually” or “often” get reports back from those partners. That figure was 23% in 2018.

About 1,400 FQHC organizations operate about 15,000 sites of service, the report states. Of the 31 million people treated in these centers, about 20 million are considered low-income, while as many as 6 million are uninsured. These centers are funded through a mixture of federal grants, Medicaid reimbursement and other sources. Often, these organizations face budget shortfalls, the report states.

“Despite their progress, community health centers are facing challenges that threaten their ability to continue offering high-quality care,” the report states. “These challenges could be exacerbated in the future, as community health centers already operate on thin financial margins due to their reliance on low Medicaid reimbursements and federal funds that have not kept up with inflation or the increased number of health centers.”

In recent years, federal policy changes have increased the number of sources of revenue FQHCs can seek but have also increased the size of their potential patient population. Last year, the U.S. Centers for Medicare & Medicaid Services (CMS) moved to increase Medicare’s coverage of addiction treatment to include intensive outpatient programs at several care sites, including FQHCs.

Increasingly, the federal government is seeking to enhance its behavioral health-specific community clinic model. The Biden administration expanded the Certified Community Behavioral Health Clinic (CCBHC) Medicaid demonstration program to 10 new states earlier in the year. CCBHCs are funded through a prospective payment model to provide comprehensive behavioral health care and physical health screening as well as social services. An appropriations bill floating around Congress includes $400 million in funding for CCBHCs.