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.