What are the Differences between a Rural Health Care Clinic and a Federally Qualified Health Center?

What is a Rural Health Clinic?

A Rural Health Care Clinic (RHC) is a clinic designed to provide quality care to patients in rural areas. They are Medicare certified programs that must be established in areas designated as rural shortage areas. An RHC is not permitted to care for patients of mental diseases or rehabilitation services. At least fifty percent of the time the clinic is open there must be a nurse practitioner, midwife, or physician assistant to provide care to patients. These medical professionals are under direction of a physician. RHCs are required to staff personnel, but there are no requirements to maintain a Board of Directors. Two types of Rural Health Clinics exist: (1) an Independent Rural Health Clinic which is a freestanding clinic not associated with a hospital or any type of Health Care Agency; and (2) a Provider Based Rural Health Clinic which is the subordinate of a hospital, home health agency or nursing facility. Also, Rural Health Clinics do not receive federal funding for start-up or expansion.

Licensing and Certification Requirements

RHCs must apply for certification with Medicare. All mandatory applications and requested documents must be submitted along with a survey. To be considered a “rural area” the Census Bureau designates non urbanized areas as rural areas during annual surveys. This is a separate designation that can only be assigned by the Census Bureau.

What is an FQHC?

A Federally Qualified Health Center are primary care outpatient centers that serve underserved communities. FQHCs qualify for reimbursements from the Health Resources and Services Administration (HRSA), Medicaid, and Medicare. An FQHC can receive government grants, donations, and private sectors in addition to the Medicaid reimbursements. To be considered a Federally Qualified Health Center a clinic must meet certain requirements including: (1) serving an underserved area; (2) provide care on a ‘sliding fee scale’ which is based on ability to pay; (3) complete required annual reports; (4) provide holistic and social services; (5) and not be approved as a rural health clinic.

What are the similarities?

Both programs are established to provide quality health care to underserved and community shortage areas. Similarly, they are capable of providing care to Medicaid and Medicare patients. They are both government established programs that were created to aid in the creation of facilities in the medically underserved areas. Because of this they can both be classified as profit or not for profit organizations. They are also equally subject to survey and review.

What are the differences?

Rural Health Clinics are only located in rural areas designated as shortage areas whereas Federally Qualified Health Centers can operate both in rural and nonrural areas with medical shortages. RHCs cannot treat mental illnesses or provide rehabilitation services. RHCs exclusively operate to serve Medicaid patients’ primary care and dental needs in rural shortage areas. FQHC’s qualify for reimbursements from Medicaid and Medicare and are required to provide care for patients in all life cycles (with the exception of pediatric clinicians). FQHCs also provide a broader scope of care for patient needs. FQHC’s are also required to provide some form of after-hours care unlike RHCs. FQHCs are expected to have hospital admitting privileges or an established hospital coverage plan to ensure continuity of care. Another difference is that RHC’s do not have requirements to serve anyone in the community while FQHC’s are required to provide care for all community residents.

From an outside perspective, both types of clinics seem very similar. While both are established to provide care for medically underserved populations (MUPS), there are many differences in requirements, staffing, type of care, and funding to take note of.


It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.


All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Jamaal Jones


This post was authored by Jamaal R. Jones, Esquire (Partner) of Jones Health Law, P.A. where we provide "On-Call Legal Services to Healthcare Professionals". For more information contact us at (305) 877-5054; email us at JRJ@JonesHealthLaw.com, or visit our website at www.JonesHealthLaw.com

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