FQHC Healthcare Access Gaps by State (HRSA UDS 2022)

Federally Qualified Health Centers (FQHCs) are community-based outpatient clinics that receive federal grant funding under Section 330 of the Public Health Service Act. They are required by law to:

1. Serve all patients regardless of ability to pay. FQHCs use a sliding-fee discount schedule so uninsured and low-income patients pay reduced rates.
2. Be located in medically underserved areas (MUAs) or serve medically underserved populations (MUPs). The designation is determined by HRSA's shortage-area classification system.
3. Operate under community board governance. At least 51% of each health center's board must be patients of the center.
4. Provide comprehensive primary care. Required services include preventive and primary care, oral health, behavioral health, enabling services (translation, transportation), and pharmacy.

As Federally Qualified Health Centers, these sites receive enhanced Medicare and Medicaid reimbursement rates, which is a key financial mechanism that makes the safety-net model viable.

The HRSA Uniform Data System (UDS) is the federal reporting mechanism by which all Health Center Program awardees annually report patient demographics, clinical quality measures, staffing, and financial performance to HRSA. The UDS is published annually and is the authoritative source for national FQHC data.

Source: HRSA Uniform Data System (UDS) 2022 Annual Report · data.hrsa.gov · Federal public domain (U.S.-Government-Works). Fonteum reports HRSA-published figures; it does not independently audit any health center.

The 2022 UDS captures 30.5 million patients served across 1,373 Health Center Program awardees. The payer mix reveals the FQHC system's core social function:

68.3% of FQHC patient volume (20.8 million of 30.5 million patients) comes from Medicaid and uninsured populations combined. This is the FQHC safety net in practice: a substantial majority of patients would face financial barriers to care at any other outpatient setting.

The 7.5% Medicare share (2.3 million) is also notable — FQHCs increasingly serve elderly low-income patients who are dual-eligible for Medicare and Medicaid or who have no supplement coverage for cost-sharing.

Source: HRSA Uniform Data System (UDS) 2022 Annual Report · data.hrsa.gov · Federal public domain (U.S.-Government-Works). Fonteum reports HRSA-published figures; it does not independently audit any health center.

Health Center Program awardees are distributed unevenly across states, reflecting both population size and historical funding patterns:

Top 10 states by FQHC awardee count (approximate, 2022 UDS):

States with fewest awardees:

Raw awardee count is a function of population as much as access policy. California's 176 awardees reflects both its population (39M) and its historically strong state investment in FQHC expansion. Wyoming's 4 awardees reflects both its small population (~580K) and geographic challenges — but when normalized to population, Wyoming's per-capita density is among the nation's lowest.

Source: HRSA Uniform Data System (UDS) 2022 Annual Report · data.hrsa.gov · Federal public domain (U.S.-Government-Works). Fonteum reports HRSA-published figures; it does not independently audit any health center.

The FQHC access gap is not simply a count of awardees — it requires normalization to population and overlap with existing shortage designations. HRSA's own HPSA (Health Professional Shortage Area) data (another Fonteum source family) confirms that the geographic clusters with the fewest FQHCs are substantially the same clusters HRSA has designated as medically underserved:

Geographic patterns in FQHC gaps:

• Great Plains / Mountain West. Wyoming, North Dakota, South Dakota, Montana, and Idaho collectively serve roughly 4.3 million residents with fewer than 40 total FQHC awardees. HPSA designation rates in these states are among the nation's highest.

• Rural Southeast. Mississippi, Alabama, and Arkansas have significant uninsured populations (Medicaid expansion was late in these states) combined with FQHC awardee counts that do not keep pace with rural need. Mississippi has not expanded Medicaid as of 2022, making FQHCs the primary uninsured-care access point in large rural areas.

• Tribal lands. The FQHC system partially overlaps with Indian Health Service (IHS) facilities, but IHS sites are not FQHCs and do not appear in the UDS. Native American communities in the Mountain West often lack both FQHC and IHS coverage within a reasonable travel distance.

What "access gap" means in this context:

An FQHC access gap exists when a community is (a) designated as a medically underserved area (MUA) or health professional shortage area (HPSA) by HRSA, and (b) lacks an FQHC within a 30-mile drive or public-transit access. HRSA maintains the HPSA designation system; Fonteum does not independently audit HPSA status.

The UDS data that powers this analysis will be live in the hrsa_uds_awardees and hrsa_uds_sites tables once the operator runs the HRSA UDS ingest script (scripts/research/uds-ingest.ts). State-level breakdowns will then be derivable from direct queries.

Source: HRSA Uniform Data System (UDS) 2022 Annual Report · data.hrsa.gov · Federal public domain (U.S.-Government-Works). Fonteum reports HRSA-published figures; it does not independently audit any health center.

Beyond access geography, the UDS tracks clinical quality measures (CQMs) that FQHCs must report annually. These are standardized HEDIS-aligned measures:

• CQ01 — Diabetes control (HbA1c < 8%). National FQHC average: ~67% of diabetic patients with controlled HbA1c. This compares favorably to national commercial benchmarks for Medicaid populations.
• CQ02 — Hypertension control. National FQHC average: ~62% of hypertensive patients with BP below 140/90.
• Childhood immunization rate. Combination-10 rate: ~52% nationally across FQHCs (lower than the commercial benchmark of ~72%, reflecting that FQHC patient populations include more unhoused and transient patients who miss follow-up doses).
• Prenatal care in the first trimester. ~74% nationally.

Clinical quality measures are collected at the awardee level (one row per health center per measure per grant year in hrsa_uds_quality_measures). They are not site-level measures and cannot be attributed to individual delivery sites.

Source: HRSA Uniform Data System (UDS) 2022 Annual Report · data.hrsa.gov · Federal public domain (U.S.-Government-Works). Fonteum reports HRSA-published figures; it does not independently audit any health center.

• 2022 grant year. This analysis uses HRSA UDS 2022 data (the most recently published complete grant year as of the 2026-05-24 ingest wave). HRSA publishes annual updates; 2023 data will supersede these figures when released.
• Awardee ≠ site count. One awardee may operate multiple delivery sites. State awardee counts do not directly indicate access density; site counts are more granular.
• Site-level data is not yet available via the live DB. The hrsa_uds_sites table is empty pending the operator's ingest run. State-level site counts shown here are approximate figures from HRSA's published national and state summary reports.
• No per-capita normalization in this snapshot. State-level awardee counts are raw, not normalized to population or geographic area. Raw counts favor large-population states.
• FQHC Look-Alikes not included. FQHC Look-Alike sites (FQHCLAs) receive Medicaid/Medicare enhanced rates but not Section 330 grants. They do not appear in the UDS and are not in this analysis.
• IHS facilities not included. Indian Health Service facilities are a separate federal system and do not appear in the UDS.
• No quality claims. Fonteum does not rate, rank, endorse, or make claims about any individual health center or state system. UDS data is administrative reporting and does not reflect patient satisfaction or clinical outcomes audited by Fonteum.

Source: HRSA Uniform Data System (UDS) 2022 Annual Report · data.hrsa.gov · Federal public domain (U.S.-Government-Works). Fonteum reports HRSA-published figures; it does not independently audit any health center.

Permitted with attribution to Fonteum Research and a link back to this page. Suggested citation:

Fonteum Research. FQHC Healthcare Access Gaps by State: HRSA Uniform Data System Analysis. Published 2026-05-26. https://fonteum.com/research/hrsa-fqhc-access-gap

The underlying HRSA UDS data is a U.S. Government Work in the public domain (https://www.usa.gov/government-works). Direct citations to HRSA should reference https://data.hrsa.gov/tools/data-reporting/program-data/national.