Integrated, Inclusive Care for Health Equity: The Role of Lesbian, Gay, Bisexual, and Transgender-Specific Community Health Centers

Background and Purpose:

Community health centers serve as primary care safety net delivery sites for uninsured and underinsured people, many of whom are affected by poverty. Lesbian, gay, bisexual, and transgender (LGBT)-specific health centers are designed to serve the needs of underserved LGBT communities, with attention to intersecting social experiences such as racial discrimination and poverty. A community health center can qualify as a federally-qualified health center (FQHC), allowing it to receive federally funding, to accept Medicare and other public insurances, and often, to expand its services. FQHC status is hard to achieve, as it requires an abundance of resources that many small, nonprofit health centers simply do not have.

Even though the Affordable Care Act carved out funding to expand FQHCs, only nine LGBT-specific health centers across the country have achieved FQHC-status. To date, no study has systematically examined these LGBT FQHCs. The current study asks: Who do LGBT FQHCs serve? What services and programs are offered? How do LGBT FQHCs attend to issues related to race, gender, and sexuality across mission and services? The objective of this study is to describe, compare and contrast the patient populations and various patient services and resources across LGBT FQHCs. 

Methods:

Nine LGBT FQHCs were identified using internet search of FQHC reports and databases. All LGBT FQHCs were located in large cities. On average, approximately 1/2 of patients were people of color, 1/7 were transgender or gender-nonconforming, and about 1/4 were insured through Medicaid. Data collected were archival and administrative data reported by the health center as mandated by federal policy. Analysis included descriptive statistics regarding patient populations and center financial resources. Qualitative coding and thematic analysis were used with narrative data, including the mission statement of each center, as well as descriptions of various respective health, human, and social services, resources, and programming.

Results:

This study found that LGBT FQHCs provide comprehensive health services, including primary medical care, mental health, sexual health, dental, vision, and pharmacy, as well as specialized behavioral health services targeted to specific sexual orientation and gender identity groups, children and youth, and the elderly. This included support groups and individual counseling concerning issues related to gender and sexuality, with particular attention to the intersections of age, race, and socioeconomic status and material resources.  In addition, resources, services, and programming inclusive of health education, legal services, housing and employment assistance, and insurance enrollment were characteristic of LGBT FQHCs.

Conclusion and Implications:

Results highlight that through an integrated, inclusive approach, LGBT-serving organizations can enhance the life trajectories of their patients, well beyond the scope of health outcomes alone. This multidimensional lens may inform strategies to expand organizational and institutional conceptualizations of what LGBT-serving health centers are, who they serve, what research is needed to document impact of LGBT FQHCs, and how policy and practice can shape LGBT health equity. Finally, this study gives insight into whether appropriate, comprehensive, and meaningful strategies, metrics, and benchmarks are used for prevention and intervention efforts, including health promotion, education, and community-based programming.