Georgia Medicaid FQHC and RHC Coverage (2026): PPS Payment, 340B, Sliding Fee, Safety-Net Access

::hero{eyebrow="Georgia Medicaid" headline="Georgia Medicaid FQHC and RHC Coverage" subhead="How Section 1905(a)(2)(C) and Section 1905(a)(2)(B) of the Social Security Act define FQHC and RHC services as mandatory Medicaid benefits, how Section 1902(bb) establishes per-encounter Prospective Payment System reimbursement with wrap payments for managed care patients, how Section 330 of the Public Health Service Act authorizes the Federal Health Center Program, how the 340B drug pricing program provides deeply discounted medications, how the sliding fee scale protects access regardless of ability to pay, and how Georgia families access primary care behavioral health dental pharmacy and care coordination through the FQHC and RHC networks."} ::

Federally Qualified Health Centers and Rural Health Clinics are the backbone of safety-net primary care in Georgia. FQHCs serve communities across Georgia through community health centers, migrant health centers, health care for the homeless programs, and public housing primary care. RHCs serve rural Georgia communities where traditional primary care infrastructure is scarce or absent. Both FQHCs and RHCs are protected under federal Medicaid law with a special Prospective Payment System reimbursement methodology that pays per encounter regardless of complexity, designed to preserve safety-net access. FQHCs are also eligible for the 340B Drug Pricing Program, gaining access to deeply discounted outpatient medications that they use to subsidize care for uninsured and underinsured patients. The sliding fee scale that FQHCs are required to maintain under Section 330(k)(3)(G) of the Public Health Service Act ensures that no patient is denied service due to inability to pay.

For Georgia families, FQHCs and RHCs are often the only practical primary care option. Uninsured Georgians can access FQHC services on a sliding fee scale, regardless of immigration status. Medicaid patients receive FQHC services at no cost. The 340B pharmacy provides medications at deeply discounted prices for FQHC patients. Many FQHCs offer adult dental care, which is otherwise rarely covered by Georgia Medicaid. FQHCs operating in rural areas, agricultural regions, urban underserved neighborhoods, homeless shelters, and public housing developments deliver primary care across populations and geographies that mainstream healthcare often does not reach.

This guide translates the FQHC and RHC framework for Georgia families. It covers the federal authorities (Section 1905(a)(2)(C) and Section 1905(a)(2)(B) of the Social Security Act, Section 1902(bb) Prospective Payment System, Section 330 of the Public Health Service Act, the Rural Health Clinic Services Act of 1977, the 340B Drug Pricing Program, FTCA coverage under Section 224 of the PHS Act, the ACA Section 10503 Community Health Center Fund, Medicare FQHC PPS at Section 1834(o), and the sliding fee scale requirement at Section 330(k)(3)(G)). It covers Georgia implementation (the Georgia Primary Care Association, DCH FQHC and RHC Provider Manuals, the Georgia State Office of Rural Health, wrap payment processing, and CMO contracting). It details the scope of services, the FQHC versus RHC distinctions, the major Georgia FQHC and RHC networks, and how to find a clinic near you. Six worked examples illustrate how FQHC and RHC services operate for real Georgia families. A frequently asked questions section addresses the most common questions families ask. A contact directory provides the phone numbers needed to navigate the system.

::callout{title="Key takeaways"}

• FQHC services are a mandatory Medicaid benefit under Section 1905(a)(2)(C) of the Social Security Act. RHC services are mandatory under Section 1905(a)(2)(B). Every state Medicaid program must cover both.
• Section 1902(bb) of the Social Security Act establishes the Prospective Payment System, a per-encounter payment methodology that protects FQHC and RHC financial viability. Per-encounter rates are adjusted annually by the Medicare Economic Index.
• The state must make wrap payments to FQHCs and RHCs to bridge the gap between managed care organization payments and the PPS rate, preserving the PPS protection in managed care arrangements.
• Section 330 of the Public Health Service Act authorizes the federal Health Center Program. FQHCs must meet Section 330 requirements including patient-governed boards (51 percent patients), sliding fee scales, comprehensive services, and enabling services.
• The 340B Drug Pricing Program provides deeply discounted outpatient medications to FQHCs and other covered entities. RHCs are generally not 340B-eligible.
• FQHC providers receive Federal Tort Claims Act coverage for medical malpractice under Section 224 of the Public Health Service Act. RHC providers carry commercial malpractice insurance.
• The sliding fee scale at Section 330(k)(3)(G) requires FQHCs to charge nominal fees for patients at or below 100 percent of the Federal Poverty Level, with graduated discounts up to 200 percent of FPL. No patient can be denied service due to inability to pay.
• FQHCs serve patients regardless of immigration status. Section 330 does not condition service on citizenship.
• Many FQHCs offer adult dental, behavioral health, substance use treatment, telehealth, and enabling services (eligibility assistance, transportation, interpretation) that mainstream providers do not offer.
• The Georgia Primary Care Association at 404-659-2861 is the statewide FQHC trade association. HRSA's Find a Health Center directory at 1-877-464-4772 identifies clinic sites by location. ::

The federal framework

By Brevy Care Team · Last verified May 12, 2026

Section 1905(a)(2)(C) and Section 1905(a)(2)(B): FQHC and RHC services as mandatory Medicaid benefits

Section 1905(a)(2)(C) of the Social Security Act defines Federally Qualified Health Center services as a mandatory Medicaid benefit category. The FQHC service includes physician services, services of physician assistants and nurse practitioners, services of certified nurse midwives, services of qualified clinical psychologists and licensed clinical social workers, and other ambulatory services furnished by an FQHC that are otherwise covered under the state plan.

Section 1905(a)(2)(B) defines Rural Health Clinic services in parallel terms. The mandatory inclusion of both FQHC and RHC services in Medicaid is a critical protection. States cannot exclude FQHCs or RHCs from Medicaid networks or refuse to cover their services. The mandatory status reflects federal policy recognition that these safety-net providers serve populations that would otherwise lack access to primary care.

Section 1902(bb): The Prospective Payment System

Section 1902(bb) of the Social Security Act (42 USC 1396a(bb)) establishes the Prospective Payment System for FQHC and RHC reimbursement. PPS replaced the prior reasonable cost reimbursement methodology with a per-encounter rate intended to preserve safety-net financial viability while limiting state administrative burden.

Key features of FQHC and RHC PPS:

1. Per-encounter rate: Each FQHC and each RHC is paid a single rate per qualifying patient encounter, regardless of the complexity of the encounter. A simple medication refill visit and a complex chronic disease visit are reimbursed at the same rate. This eliminates the disincentive that fee-for-service creates for providers to spend adequate time with complex patients.
2. Encounter definition: A face-to-face encounter between a patient and a qualified provider (physician, nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker). Some encounter types are billed separately under separate PPS rates (medical, dental, behavioral health at FQHCs with separately authorized dental and behavioral health PPS rates).
3. Rate establishment: PPS rates are established at FQHC or RHC certification based on reasonable cost during a baseline year. The rate is specific to each FQHC and each RHC, reflecting that center's cost structure and patient mix.
4. Annual MEI adjustment: PPS rates are adjusted annually by the Medicare Economic Index (MEI) to reflect inflation in physician practice costs.
5. Wrap payment for managed care: Section 1902(bb)(5) requires that when an FQHC or RHC patient is enrolled in a Medicaid managed care organization (MCO/CMO), the state must make a supplemental "wrap" payment to the FQHC or RHC to bridge the gap between the MCO's payment and the PPS rate. The wrap payment preserves PPS protection in managed care arrangements.
6. Alternative Payment Methodology: Section 1902(bb)(6) authorizes states and FQHCs to mutually agree on an alternative payment methodology that pays at least as much as PPS would have paid. APMs have been used in some states to develop value-based payment models for FQHCs while preserving the underlying PPS protection.

Section 330 of the Public Health Service Act

Section 330 of the Public Health Service Act (42 USC 254b) authorizes the federal Health Center Program administered by the Health Resources and Services Administration's (HRSA) Bureau of Primary Health Care. Section 330 grants are awarded to community-based, patient-governed health centers that provide primary care to medically underserved populations.

The Health Center Program has four sub-programs:

• Section 330(e): Community Health Centers serving general underserved populations
• Section 330(g): Migrant Health Centers serving migratory and seasonal farmworkers and their dependents
• Section 330(h): Health Care for the Homeless programs serving homeless individuals
• Section 330(i): Public Housing Primary Care serving residents of public housing

To qualify as an FQHC, an organization must meet Section 330 program requirements regardless of whether the organization receives a Section 330 grant. Organizations that meet all Section 330 requirements but do not receive grant funding are called "FQHC Look-Alikes" and receive FQHC Medicaid PPS payment without the federal grant.

Section 330 requirements include:

• Patient-governed board (at least 51 percent of board members must be patients of the health center)
• Sliding fee scale based on family income (no one denied service due to inability to pay)
• Comprehensive primary care services
• Enabling services (transportation, interpretation, eligibility assistance, outreach)
• Quality assurance and improvement programs
• Cultural competency
• Service to medically underserved populations
• Federal financial requirements and accountability

Affordable Care Act Section 10503: Community Health Center Fund

Section 10503 of the Affordable Care Act of 2010 (Public Law 111-148) created the Community Health Center Fund, a dedicated funding stream for Section 330 health centers. The CHCF has been extended multiple times through subsequent legislation and currently provides multi-billion-dollar annual funding for FQHC operations and expansion.

340B Drug Pricing Program

The 340B Drug Pricing Program, authorized by Section 340B of the Public Health Service Act (42 USC 256b), requires pharmaceutical manufacturers to provide outpatient drugs to eligible "covered entities" at deeply discounted "ceiling prices." Covered entities include:

• Section 330 grantees (FQHCs)
• FQHC Look-Alikes
• Disproportionate Share Hospitals meeting specific criteria
• Critical Access Hospitals
• Sole Community Hospitals meeting specific criteria
• Rural Referral Centers meeting specific criteria
• Cancer hospitals
• Children's hospitals
• Tuberculosis hospitals
• Black lung clinics
• Title X family planning clinics
• Ryan White HIV/AIDS Program grantees

The savings allow FQHCs to provide affordable medications to uninsured patients, subsidize other safety-net care, expand services, and hire additional providers.

FQHCs typically dispense 340B drugs through in-house pharmacies and through contract pharmacy arrangements with retail pharmacies. The 340B program requires detailed inventory accounting, audit trails, and patient eligibility verification.

Rural Health Clinics generally are NOT eligible for 340B, with narrow exceptions for RHCs affiliated with eligible hospital types (such as RHCs that are provider-based at a Critical Access Hospital, where the underlying CAH is 340B-eligible).

Federal Tort Claims Act coverage for FQHC providers

Section 224 of the Public Health Service Act extends Federal Tort Claims Act coverage to FQHC officers, board members, employees, and contractors for medical malpractice claims arising from clinical services. FTCA coverage means the federal government, not the FQHC or individual provider, defends and pays claims. The federal government's deep pockets and federal court jurisdiction substantially reduce both the actual cost and the insurance cost of medical malpractice liability for FQHC providers.

FTCA coverage is a major recruitment and retention advantage for FQHCs. Physicians, nurse practitioners, physician assistants, and other clinical providers benefit from federal malpractice protection without paying commercial malpractice insurance premiums. RHCs do NOT have FTCA coverage. RHC providers must purchase commercial medical malpractice insurance.

Sliding fee scale requirement

Section 330(k)(3)(G) of the Public Health Service Act requires FQHCs to maintain a sliding fee discount schedule for individuals and families with incomes at or below 200 percent of the Federal Poverty Level. The sliding fee schedule must:

• Adjust charges based on family size and income
• Provide a nominal charge for patients with incomes at or below 100 percent of FPL
• Provide graduated discounts between 100 and 200 percent of FPL
• Be applied to all services
• Not deny service to anyone based on inability to pay

The sliding fee scale is a critical access protection for uninsured and underinsured patients. It applies to patients regardless of immigration status, regardless of insurance status, and regardless of any other characteristic. An uninsured patient who walks into an FQHC will pay no more than the sliding fee scale amount for the services received.

Rural Health Clinic Services Act of 1977

The Rural Health Clinic Services Act of 1977 (Public Law 95-210) created the RHC program. Unlike FQHCs, RHCs are not required to have patient-governed boards or sliding fee scales. RHCs must:

• Be located in non-urbanized areas as defined by the Census Bureau
• Be located in an area designated as a Health Professional Shortage Area, Medically Underserved Area, or Medically Underserved Population
• Employ or contract with at least one nurse practitioner, physician assistant, or certified nurse midwife
• Be certified by the Centers for Medicare and Medicaid Services
• Meet conditions of certification at 42 CFR 491

RHCs can be hospital-based (provider-based, affiliated with a hospital) or independent (free-standing). Many Georgia RHCs are affiliated with Critical Access Hospitals or other rural hospitals, while others are independent practices in small towns.

Medicare FQHC and RHC PPS

FQHCs and RHCs are also reimbursed under PPS in Medicare. Medicare FQHC PPS at Section 1834(o) of the Social Security Act uses a single national base rate adjusted by geographic factors and patient acuity. Medicare RHC PPS uses an annually-adjusted per-encounter rate similar to the Medicaid methodology. For dual-eligible patients (Medicare plus Medicaid), Medicare pays as primary and Medicaid pays the remaining cost-sharing amount, with FQHCs and RHCs sometimes receiving both Medicare and Medicaid wrap payments.

Federal Office of Rural Health Policy

The Federal Office of Rural Health Policy, within HRSA, supports rural health programs including RHCs through technical assistance, the State Office of Rural Health grants, the Medicare Rural Hospital Flexibility Program (Flex), and other initiatives. The federal investment in rural primary care infrastructure includes RHCs, Critical Access Hospitals, the National Health Service Corps, and state rural health systems.

National Health Service Corps

The National Health Service Corps provides scholarships and loan repayment to primary care, dental, and behavioral health providers in exchange for service in Health Professional Shortage Areas. FQHCs and RHCs are common NHSC service sites. NHSC providers are a key workforce pipeline for the safety-net delivery system. NHSC clinicians serve in rural Georgia, urban underserved Atlanta, and homeless health programs across the state.

FQHC vs RHC: How they compare

The following distinctions matter for patients, providers, and policymakers:

::table{caption="FQHC vs RHC comparison"}

Both FQHCs and RHCs are essential safety-net providers, but they serve different roles. FQHCs are comprehensive, multidisciplinary community health centers operating in both urban and rural areas. RHCs are primary care-focused providers in non-urbanized HPSA, MUA, or MUP areas. Some communities have both an FQHC and one or more RHCs. Some communities rely entirely on RHCs because no FQHC has been established. A few urban underserved neighborhoods rely entirely on FQHCs because the area is too urbanized for RHC designation.

The Georgia framework

Georgia FQHC network

Georgia has numerous FQHC organizations operating clinic sites across the state. The Georgia Primary Care Association is the statewide FQHC trade association, providing advocacy, training, and technical assistance. The phone number is 404-659-2861.

Major Georgia FQHCs include:

• Mercy Care (Atlanta): One of Georgia's largest FQHCs, with multiple sites in metro Atlanta including the Health Care for the Homeless program at downtown shelters.
• Whitefoord Inc. (Atlanta): School-based health centers and adult primary care serving East Atlanta.
• Family Health Centers Atlanta: Multiple Atlanta locations focused on underserved populations.
• Southside Medical Center (Atlanta): Comprehensive primary care, behavioral health, and dental services.
• Mercy Care of Macon (St. Joseph's Mercy Care): FQHC in middle Georgia.
• Curtis V. Cooper Primary Health Care (Savannah): Coastal Georgia FQHC.
• Coastal Community Health (Savannah area): Coastal Georgia FQHC.
• Albany Area Primary Health Care: Southwest Georgia FQHC with multiple sites including a Migrant Health Center.
• Diversity Health Center: Multi-site FQHC serving diverse populations.
• Family Health Centers of Georgia: FQHC operating multiple sites.
• Premier Health: FQHC with rural and metro sites.

Georgia Migrant Health Centers serve farmworkers and their dependents primarily in agricultural regions including southwest Georgia, south central Georgia, and southeast Georgia. The Health Care for the Homeless programs operate in Atlanta, Savannah, Macon, Columbus, and Albany. School-Based Health Centers are operated by many FQHCs in partnership with local school districts.

Georgia RHC network

Georgia has numerous RHCs distributed across rural counties. Many Georgia RHCs are provider-based (affiliated with a Critical Access Hospital or other rural hospital), while others are independent practices. Counties where rural primary care access is heavily dependent on RHCs include large portions of southwest Georgia, southeast Georgia, the central Georgia peanut belt, the Appalachian foothills in north Georgia, and the rural counties surrounding Augusta and Columbus.

The Georgia State Office of Rural Health, within DCH, supports RHC operations through technical assistance and coordination. The State Office of Rural Health is located in Cordele and reachable at 229-401-3090. The office administers federal Medicare Rural Hospital Flexibility Program (Flex) funding for Georgia and provides technical assistance to rural providers.

DCH FQHC and RHC Provider Manuals

The DCH FQHC Provider Manual and the DCH RHC Provider Manual establish operational rules for Georgia Medicaid reimbursement of FQHC and RHC services. The manuals specify provider enrollment requirements, encounter definitions and billing codes, PPS rate-setting and rebase procedures, wrap payment processing for managed care patients, quality reporting requirements, and audit procedures.

Wrap payment processing in Georgia

The wrap payment is the supplemental payment from Georgia DCH that bridges the gap between the CMO's capitated payment for a managed-care-enrolled FQHC or RHC patient and the provider's PPS rate. The wrap payment process operates as follows:

1. FQHC or RHC provides service to managed care patient and bills the CMO
2. CMO pays the FQHC or RHC at the CMO's contracted rate (usually less than PPS)
3. FQHC or RHC submits a wrap payment claim to DCH
4. DCH calculates the difference between the CMO payment and the FQHC's or RHC's PPS rate
5. DCH pays the difference (the "wrap") to the FQHC or RHC

The wrap payment process ensures FQHC and RHC PPS protection survives managed care expansion. Without wrap payments, FQHCs and RHCs would be financially harmed by CMO enrollment, which would undermine the Section 1902(bb) statutory protection. The wrap payment process is administratively complex but financially essential.

CMO contracting with FQHCs and RHCs

The Care Management Organizations contract with FQHCs and RHCs as in-network primary care providers. CMO members enrolled with an FQHC or RHC receive their primary care from that provider. The CMO pays the FQHC or RHC according to the CMO-FQHC/RHC contract, with the state wrap payment adjusting to the PPS rate.

CMO contracts typically include capitation or fee-for-service payment terms, quality measure expectations (HEDIS measures), care coordination expectations, member assignment processes, and telehealth provisions.

Scope of services in detail

FQHC service scope

FQHCs offer comprehensive primary care plus a wide range of additional services. A typical FQHC scope includes:

Medical

• Well-child visits including EPSDT comprehensive screenings
• Pediatric primary care
• Adolescent primary care including sensitive services
• Adult primary care
• Geriatric primary care
• Preventive screenings (Pap, mammogram referral, colorectal screening, lung cancer screening for eligible smokers)
• Immunizations including childhood and adult schedules
• Chronic disease management (diabetes, hypertension, asthma, COPD, heart disease)
• Acute care for sick visits
• Family planning (contraception, preconception counseling)
• Prenatal care at FQHCs with on-site obstetric services; referral to OB at others
• Postpartum care including the extended postpartum window
• HIV care and Pre-Exposure Prophylaxis (PrEP)
• Hepatitis C treatment
• Sexually transmitted infection screening and treatment
• Tuberculosis screening and treatment

Behavioral health

• Mental health assessment and treatment
• Depression and anxiety counseling
• Substance use treatment including medications for opioid use disorder (MOUD)
• Integrated behavioral health (warm handoff from primary care to on-site behavioral health provider)
• Behavioral health emergency triage
• Coordination with community behavioral health providers for specialty needs

Dental

• Preventive dental services (cleanings, fluoride, sealants)
• Dental cleanings
• Restorative dentistry (fillings)
• Extractions
• Some FQHCs offer dental for children only; others offer adult dental
• Dental coverage at FQHCs is one of the most valuable services because Georgia Medicaid does not cover most adult dental services through traditional providers
• 340B-discounted dental medications

Pharmacy

• 340B pharmacy with discounted medications
• On-site dispensing at some FQHCs
• Contract pharmacy arrangements at most FQHCs (the FQHC maintains a contract with retail pharmacies that dispense 340B drugs)
• Diabetic supplies
• Reproductive health supplies
• Naloxone and other harm reduction supplies

Enabling services

• Eligibility assistance (Medicaid enrollment through Right from the Start Medicaid, ACA Marketplace, PeachCare for Kids)
• Transportation assistance
• Interpretation and translation in major languages
• Health education and patient education
• Case management for chronic disease and complex social needs
• Outreach to special populations including farmworkers, homeless individuals, public housing residents
• Social work for housing assistance, food insecurity, intimate partner violence

Specialty integration

• Some FQHCs offer obstetric care, podiatry, optometry, audiology, or other specialty services on-site
• Most FQHCs have referral networks for specialty care not provided on-site
• Telehealth specialty care including tele-psychiatry and tele-MFM

RHC service scope

RHCs offer primary care and some preventive services. A typical RHC scope includes:

• Adult and pediatric primary care
• Acute and chronic disease management
• Preventive services (well-child, well-woman, immunizations)
• Some immunizations
• Some behavioral health (often as primary care behavioral health integration rather than specialty behavioral health)
• Some telehealth (RHCs are eligible originating and distant sites for Medicare telehealth)
• Lab and basic diagnostic services
• Some prescription dispensing (not 340B except in narrow circumstances)

RHCs generally do NOT offer dental services, 340B pharmacy, comprehensive enabling services, substance use treatment with MOUD at most RHCs, or specialty services. RHCs are primarily primary care destinations for rural communities.

Worked examples

Aisha, 22, Atlanta: Pregnant uninsured, transitions to Pregnancy Medicaid through FQHC

Aisha is 22, working part-time at a restaurant, uninsured, and recently learned she is pregnant. She walks into Whitefoord Inc.'s clinic in East Atlanta after her boyfriend's mother recommended it. The front desk staff explain that Whitefoord is an FQHC with a sliding fee scale, that she can be seen today regardless of insurance, and that there is also a Right from the Start Medicaid Outreach Worker on site who can help her apply for Pregnancy Medicaid.

Aisha's first visit is billed at the sliding fee minimum (about $20) given her income. The RSM Outreach Worker takes her Medicaid application and obtains presumptive eligibility for Pregnancy Medicaid the same day. Aisha is enrolled with Amerigroup Community Care as her CMO and continues prenatal care at Whitefoord. Whitefoord bills Amerigroup for ongoing visits. The state pays a wrap payment to Whitefoord to bridge the gap between Amerigroup's contracted rate and Whitefoord's PPS rate. The 340B pharmacy provides Aisha's prenatal vitamins at low cost.

Marcus, 45, Macon: Diabetic uninsured at Mercy Care of Macon

Marcus is 45, recently laid off, uninsured, and managing Type 2 diabetes diagnosed three years ago. His ACA Marketplace coverage lapsed when his job ended. He goes to Mercy Care of Macon (an FQHC) where his primary care provider has been for years. The FQHC sliding fee scale applies given his current zero income.

Mercy Care provides his diabetes follow-up visit at the nominal fee. The 340B pharmacy provides his metformin and insulin at deeply discounted prices. The Mercy Care enrollment specialist also helps Marcus apply for Georgia's Pathways to Coverage Medicaid demonstration. Marcus enrolls in job training through Goodwill and meets the Pathways requirement, gaining Medicaid coverage. Once enrolled, his Pathways Medicaid pays for the visits and 340B continues providing affordable medications.

Tonya, 28, rural southwest Georgia: Pregnant at Albany Area Primary Health Care

Tonya is 28, pregnant with her second child, living in a small town outside Albany. Her nearest hospital with obstetric services is 45 minutes away. She is enrolled in Pregnancy Medicaid through Peach State Health Plan. She receives prenatal care at Albany Area Primary Health Care, an FQHC with prenatal services on-site. Albany Area also operates a Migrant Health Center serving farmworkers in the surrounding agricultural region, although Tonya is not a farmworker.

Tonya's care includes routine prenatal visits, ultrasounds, gestational diabetes screening, and behavioral health screening. Albany Area refers her to maternal-fetal medicine through telehealth (tele-MFM) when an ultrasound shows borderline fetal growth, avoiding a long drive to Macon or Atlanta. Albany Area also provides her newborn pediatric care after delivery. The 12-month postpartum Medicaid coverage covers her ongoing postpartum visits and behavioral health.

Jamil, 8, Savannah: Autism services through Curtis V. Cooper FQHC

Jamil is 8 years old with autism spectrum disorder. His mother takes him to Curtis V. Cooper Primary Health Care in Savannah, an FQHC, for well-child care, EPSDT screening, and behavioral health integration. Curtis V. Cooper conducts the EPSDT comprehensive screening, identifies developmental concerns, and refers Jamil to a developmental pediatrician for autism diagnosis confirmation. After diagnosis, Curtis V. Cooper coordinates with the school district for Individualized Education Program (IEP) services and with a community behavioral health provider for Applied Behavior Analysis (ABA) therapy authorized under Georgia Medicaid's EPSDT coverage. Curtis V. Cooper's behavioral health integration provides on-site counseling for Jamil and family support.

Diana, 72, rural east Georgia: Lincoln County RHC

Diana is 72, lives in Lincolnton (Lincoln County, east Georgia near Augusta), and has both Medicare and Medicaid (dual eligible). Her local RHC, affiliated with the local critical access hospital, is the only primary care option within 30 miles. The RHC provides her chronic disease management for hypertension and osteoarthritis, annual wellness visits, and coordination with specialists in Augusta when needed. The RHC bills Medicare as primary and Medicaid as secondary. The Medicaid payment is at the RHC's PPS rate. The RHC also provides telehealth visits when Diana cannot drive to the clinic. Because the RHC is provider-based at a Critical Access Hospital, the affiliated CAH may also access 340B for certain pharmaceuticals, but the RHC itself does not have direct 340B eligibility.

Tyrell, 19, homeless in Atlanta: Mercy Care Health Care for the Homeless

Tyrell is 19, homeless, and aged out of foster care six months ago. He has been couch-surfing and staying at a downtown Atlanta shelter. He developed a severe respiratory infection that the shelter staff recommended he address immediately. He goes to Mercy Care's Health Care for the Homeless clinic at the shelter. The clinic provides his urgent visit at no charge (Mercy Care's sliding fee covers homeless patients at zero out-of-pocket cost). The 340B pharmacy provides his antibiotics at no charge.

The Mercy Care enrollment specialist also helps Tyrell apply for the former-foster-care Medicaid category and for Georgia's Pathways to Coverage. Tyrell is approved for former-foster-care Medicaid, which provides comprehensive coverage. He continues care at Mercy Care for ongoing primary care, behavioral health (he has been struggling with anxiety and depression since aging out), and connections to housing assistance through Mercy Care's enabling services and social work team.

Common pitfalls

1. Believing FQHCs only serve Medicaid patients: FQHCs serve all patients regardless of insurance. The sliding fee scale ensures access for uninsured patients.
2. Believing FQHCs check immigration status: Section 330 does not condition service on citizenship or immigration status. FQHCs serve all patients including undocumented patients.
3. Not knowing about 340B pharmacy: Many FQHC patients do not realize their FQHC pharmacy provides deeply discounted medications. Ask about 340B at your FQHC.
4. Not knowing the wrap payment exists: FQHCs are paid at PPS rates even when patients are in managed care. The wrap payment from the state preserves PPS protection without patients having to do anything.
5. Confusing FQHCs with FQHC Look-Alikes: Look-Alikes meet Section 330 standards but do not receive Section 330 federal grants. They still receive FQHC PPS payment and offer the same patient protections.
6. Believing RHCs are FQHCs: RHCs and FQHCs are different programs with different rules. RHCs do not have 340B, FTCA coverage, sliding fee requirement, or board governance requirement.
7. Not using the FQHC dental benefit: Adult dental at an FQHC is one of the most valuable services because traditional Georgia Medicaid does not cover most adult dental services.
8. Not using FQHC enabling services: Eligibility assistance, transportation, and interpretation are real services worth using. The eligibility assistance can help you enroll in Medicaid, Pathways to Coverage, ACA Marketplace, or PeachCare for Kids.
9. Believing FTCA covers RHC providers: Only FQHC providers have FTCA coverage. RHC providers carry commercial malpractice insurance.
10. Not knowing about School-Based Health Centers: Many FQHCs operate SBHCs in partner school districts, providing primary care to students on school grounds.
11. Not knowing about Migrant Health Centers: Farmworkers and their dependents can access dedicated migrant health programs in agricultural regions.
12. Not knowing about Health Care for the Homeless: Homeless individuals have dedicated FQHC services in major Georgia cities.
13. Not asking for the sliding fee scale: Uninsured patients sometimes pay full price by mistake when they could have qualified for the sliding fee. Ask the front desk about the sliding fee scale.
14. Not knowing about telehealth at FQHCs and RHCs: Both FQHCs and RHCs offer telehealth, which can save travel time and reduce barriers.

::accordion{title="Frequently asked questions"} ::accordion-item{title="What is the difference between an FQHC and an RHC?"} FQHCs are Federally Qualified Health Centers authorized under Section 330 of the Public Health Service Act. They have patient-governed boards (at least 51 percent of board members must be patients), sliding fee scales, comprehensive primary care plus behavioral health and dental, 340B drug pricing, and FTCA medical malpractice coverage for providers. RHCs are Rural Health Clinics authorized under the Rural Health Clinic Services Act of 1977. They must be located in non-urbanized HPSA, MUA, or MUP areas. RHCs do not have patient-board, sliding fee scale, 340B, or FTCA. Both FQHCs and RHCs are paid by Medicaid under the Prospective Payment System per-encounter methodology. :: ::accordion-item{title="Can I go to an FQHC if I do not have insurance?"} Yes. FQHCs are required by Section 330(k)(3)(G) of the Public Health Service Act to maintain a sliding fee scale for patients with incomes at or below 200 percent of the Federal Poverty Level. Patients at or below 100 percent of FPL pay only a nominal fee. Patients between 100 and 200 percent of FPL pay a graduated discount. No patient can be denied service due to inability to pay. The sliding fee applies regardless of insurance status, immigration status, or any other characteristic. :: ::accordion-item{title="Do FQHCs check immigration status?"} No. Section 330 of the Public Health Service Act does not condition service on citizenship or immigration status. FQHCs serve all patients including documented immigrants, undocumented immigrants, and U.S. citizens. The FQHC may ask for income information to apply the sliding fee scale, but the FQHC does not report immigration status to immigration authorities. :: ::accordion-item{title="What is the 340B drug pricing program?"} The 340B Drug Pricing Program, authorized by Section 340B of the Public Health Service Act (42 USC 256b), requires pharmaceutical manufacturers to provide outpatient drugs to eligible "covered entities" at deeply discounted ceiling prices. FQHCs are eligible covered entities and use 340B savings to provide affordable medications to uninsured and underinsured patients and to subsidize other safety-net care. If you receive primary care at an FQHC, ask about the 340B pharmacy. The savings can be substantial, particularly for expensive medications like insulin, HIV antiretrovirals, or hepatitis C treatments. :: ::accordion-item{title="What does the FQHC sliding fee scale cover?"} The sliding fee scale applies to all services provided by the FQHC, including medical, dental, behavioral health, and pharmacy. Patients at or below 100 percent of the Federal Poverty Level typically pay a nominal fee. Patients between 100 and 200 percent of FPL pay graduated discounted charges. The FQHC may also apply the sliding fee to procedures and services beyond the basic encounter (e.g., dental restorations, behavioral health sessions). :: ::accordion-item{title="What is the Prospective Payment System?"} The Prospective Payment System (PPS) is the Medicaid reimbursement methodology for FQHCs and RHCs, established by Section 1902(bb) of the Social Security Act. PPS pays a single per-encounter rate to the FQHC or RHC regardless of the complexity of the visit. Rates are specific to each FQHC and each RHC, established at certification based on reasonable cost, and adjusted annually by the Medicare Economic Index. The PPS methodology protects FQHC and RHC financial viability by ensuring adequate payment for safety-net services. :: ::accordion-item{title="What is the wrap payment?"} When an FQHC or RHC patient is enrolled in a Medicaid managed care organization, the MCO typically pays the FQHC or RHC at a rate lower than the PPS rate. Section 1902(bb)(5) of the Social Security Act requires the state to make a supplemental "wrap" payment to the FQHC or RHC to bridge the gap between the MCO payment and the PPS rate. The wrap payment preserves PPS protection in managed care. As a patient, you do not need to do anything for the wrap payment to occur; it happens automatically between the state and the FQHC or RHC. :: ::accordion-item{title="Does an FQHC offer dental care?"} Many FQHCs offer dental care including preventive cleanings, restorative dentistry (fillings), and extractions. Some FQHCs offer dental for children only; others offer adult dental as well. FQHC dental is particularly valuable because Georgia Medicaid does not cover most adult dental services through traditional dental providers, so FQHC adult dental fills a major coverage gap. Ask your FQHC whether dental is available on-site or by referral within the FQHC network. :: ::accordion-item{title="Can FQHCs and RHCs do telehealth visits?"} Yes. Both FQHCs and RHCs can deliver telehealth services. For Medicaid, Georgia DCH covers telehealth at FQHC and RHC PPS rates when the encounter meets the encounter definition. FQHCs and RHCs are eligible as both originating sites (the patient's location) and distant sites (the provider's location) for telehealth. Many FQHCs offer telehealth visits for primary care follow-up, chronic disease management, and behavioral health. Tele-psychiatry, tele-MFM, and tele-dermatology are common specialty telehealth services offered through FQHC networks. :: ::accordion-item{title="How do I find an FQHC or RHC near me?"} Use HRSA's Find a Health Center directory at findahealthcenter.hrsa.gov or by phone at 1-877-464-4772. The directory identifies all Section 330 grantees and FQHC Look-Alikes by location and lists their addresses, phone numbers, and basic service information. For RHCs, contact the Georgia State Office of Rural Health at 229-401-3090 or the Georgia Primary Care Association at 404-659-2861. :: ::accordion-item{title="What is the National Health Service Corps?"} The National Health Service Corps (NHSC) provides scholarships and loan repayment to primary care, dental, and behavioral health providers in exchange for service in Health Professional Shortage Areas. FQHCs and RHCs are common NHSC service sites. The program brings clinicians to underserved communities. If you are a clinician interested in safety-net practice, contact NHSC for current loan repayment award amounts. The phone number is 1-800-221-9393. :: ::accordion-item{title="What is the Federal Tort Claims Act coverage?"} Section 224 of the Public Health Service Act extends Federal Tort Claims Act (FTCA) coverage to FQHC officers, board members, employees, and contractors for medical malpractice claims arising from clinical services. The federal government, not the FQHC or individual provider, defends and pays claims. This dramatically reduces the cost of medical malpractice insurance for FQHC providers and is a major recruitment and retention advantage. RHCs do NOT have FTCA coverage. RHC providers must purchase commercial malpractice insurance. :: ::

::cta{title="Need help finding a Georgia FQHC or RHC?" body="Call the numbers below to find a federally qualified health center or rural health clinic in your area, learn about the sliding fee scale, ask about 340B medications, or get help applying for Medicaid through an FQHC outreach worker."}

Georgia FQHC and RHC contacts:

• HRSA Find a Health Center: 1-877-464-4772
• Georgia Primary Care Association: 404-659-2861
• Georgia State Office of Rural Health: 229-401-3090
• DCH Medicaid Member Services: 1-866-211-0950
• Mercy Care (Atlanta): 1-678-843-8500
• Whitefoord Inc. (Atlanta): 1-404-371-0091
• Albany Area Primary Health Care: 229-431-1500
• Curtis V. Cooper Primary Health Care (Savannah): 912-527-1000
• Family Health Centers of Georgia: 404-525-3777
• Southside Medical Center: 404-688-1350
• Right from the Start Medicaid Outreach Program: 1-800-809-7276
• National Health Service Corps: 1-800-221-9393
• Healthy Mothers Healthy Babies Coalition of Georgia: 1-800-822-2229
• Amerigroup, CareSource, Peach State, Wellpoint Member Services: see Medicaid member services for current contacts

Find personalized help navigating Georgia FQHC and RHC services at brevy.com.

::

Internal links and further reading

For related coverage, see:

• Georgia Medicaid hub
• Pregnancy Coverage
• Behavioral Health Coverage
• Telehealth Coverage
• Children and EPSDT
• Dental Coverage
• Prescription Drug Coverage
• Pathways to Coverage

Disclaimer

This guide is provided by the Brevy Care Team as a public educational resource on Brevy.com. The information reflects Georgia Medicaid policy as of May 12, 2026 and is based on Section 1905(a)(2)(C) and Section 1905(a)(2)(B) of the Social Security Act, Section 1902(bb), Section 330 of the Public Health Service Act, the Rural Health Clinic Services Act of 1977, Section 340B of the Public Health Service Act, Section 224 of the Public Health Service Act, Section 10503 of the Affordable Care Act, 42 CFR 405.2401-2472, 42 CFR 491, and the Georgia DCH FQHC and RHC Provider Manuals. Sliding fee scales, scope of services, and specific FQHC and RHC offerings vary by clinic. This guide is not legal, medical, or financial advice. For specific guidance about your situation contact the Georgia Primary Care Association at 404-659-2861, HRSA Find a Health Center at 1-877-464-4772, or DCH Medicaid Member Services at 1-866-211-0950.