News publications and other organizations are encouraged to reuse Direct Relief-published content for free under a Creative Commons License (Attribution-Non-Commercial-No Derivatives 4.0 International), given the republisher complies with the requirements identified below.

When republishing:

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  • With Direct Relief's permission, news publications can make changes such as localizing the content for a particular area, using a different headline, or shortening story text. To confirm edits are acceptable, please check with Direct Relief by clicking this link.
  • If new content is added to the original story — for example, a comment from a local official — a note with language to the effect of the following must be included: "Additional reporting by [reporter and organization]."
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Republishing Images:

Unless stated otherwise, images shot by Direct Relief may be republished for non-commercial purposes with proper attribution, given the republisher complies with the requirements identified below.

  • Maintain correct caption information.
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  • Do not digitally alter images.

Direct Relief often contracts with freelance photographers who usually, but not always, allow their work to be published by Direct Relief’s media partners. Contact Direct Relief for permission to use images in which Direct Relief is not credited in the caption by clicking here.

Other Requirements:

  • Do not state or imply that donations to any third-party organization support Direct Relief's work.
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  • Advance permission is required to translate Direct Relief's stories into a language different from the original language of publication. To inquire, contact us here.
  • If Direct Relief requests a change to or removal of republished Direct Relief content from a site or on-air, the republisher must comply.

For any additional questions about republishing Direct Relief content, please email the team here.

Medicaid patients surpass uninsured at safety net clinics, but why?


Direct Relief’s State of the Safety Net 2012 report observed a major shift since 2007 in the number of Medicaid patients seen at Federally Qualified Health Centers (FQHCs) relative to the number of uninsured patients. By 2010, the number of persons using Medicaid exceeded the number of uninsured for the first time since data was collected on FQHCs. Subsequent conversations about the report with a wide range of people encouraged Direct Relief to dig into some of the possible causes and consequences of this shift for patients and for safety net health centers.

Why have so many people using Medicaid been seen at FQHCs? Has the increase relative to the number of uninsured persons improved economic circumstances at health centers? Or has this trend been a source of additional economic pressure?

One provocative graph posted online in July by the National Priorities Project pointed toward persistently high unemployment as the key driver of growth in the nation’s Medicaid rolls. As people become and stay unemployed, their incomes fall and they become eligible for Medicaid. Since 2007, record numbers of Americans have taken advantage of Medicaid’s availability and the willingness of safety-net institutions to accept Medicaid payments as a way to meet their families’ healthcare needs. Total enrollment in Medicaid is up almost 10 percent since the start of the recession in 2008. Federal policy has also made a difference. At the same time more Americans were becoming eligible for coverage, state Medicaid spending was heavily supported by the American Recovery and Reinvestment Act.

In upcoming posts, Direct Relief will take a deeper look at these questions through new research on the economics of Medicaid, conversations with safety net health workers, and recent federal data on the remarkable variability of Medicaid costs across different states. As with so many things, the effects of these changes in insurance and economic status often depend upon where in the world they’re happening.

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