CHC in healthcare most commonly refers to one of two things depending on where you are: Community Health Centers in the United States or NHS Continuing Healthcare in the United Kingdom. Both are major programs that serve millions of people, but they work very differently. Community Health Centers are clinics that provide affordable primary care to underserved communities. NHS Continuing Healthcare is a funding arrangement that covers the full cost of long-term care for adults with complex health needs.
Community Health Centers in the US
A Community Health Center (CHC) is a nonprofit or public clinic that provides primary care services regardless of a patient’s ability to pay. These centers operate under the Health Center Program, administered by the Health Resources and Services Administration (HRSA), and must meet specific federal requirements to receive funding or earn designation as a Federally Qualified Health Center (FQHC). To qualify, a CHC must be either a private nonprofit or a public agency, deliver primary care within its approved service area, and operate independently rather than as a subsidiary of another organization.
CHCs exist to fill gaps in healthcare access. They’re typically located in areas where people face barriers to getting medical care, whether that’s due to poverty, geographic isolation, homelessness, or lack of insurance. The clinics serve everyone who walks in, but their core mission is reaching populations that would otherwise go without care.
Services CHCs Must Provide
Federal law requires Community Health Centers to offer a broad range of services. The mandatory list includes primary care across family medicine, internal medicine, pediatrics, and obstetrics/gynecology, along with diagnostic lab work, radiology, emergency medical services, and pharmacy services. Preventive care is also required: prenatal and perinatal care, cancer screenings, well-child visits, immunizations, lead level screenings, cholesterol checks, communicable disease testing, and preventive dental services for children.
CHCs must also provide referrals to specialists when medically needed, including mental health and substance use disorder services. In practice, many larger CHCs offer behavioral health, dental care, and vision services on-site, making them a one-stop option for patients who would otherwise need to navigate multiple providers.
How the Sliding Fee Scale Works
One of the defining features of a CHC is its sliding fee discount program. Every federally funded health center is required to adjust what patients pay based on household income relative to the Federal Poverty Guidelines.
- At or below 100% of the poverty line: You receive a full discount. The center may charge a small nominal fee, but it must be less than what the next income bracket pays.
- Between 100% and 200% of the poverty line: You pay a partial fee based on your income, with at least three graduated discount levels in this range.
- Above 200% of the poverty line: You pay the full fee for services, though these fees are generally lower than what private practices charge.
No one is turned away for inability to pay. This structure makes CHCs a critical safety net for uninsured and underinsured patients.
Patient-Led Governance
Community Health Centers have an unusual governance requirement: at least 51% of the governing board must be patients of the center. Boards range from 9 to 25 members, and the patient members must collectively represent the demographics of the community the center serves. A “patient” for board purposes is anyone who received care at the center within the past 24 months, or a legal guardian or healthcare decision-maker for a dependent patient. This structure is designed to keep the centers accountable to the people they serve rather than to outside interests.
NHS Continuing Healthcare in the UK
In the UK, CHC almost always refers to NHS Continuing Healthcare, a package of ongoing health and social care that the NHS arranges and funds entirely. It’s available to adults aged 18 and over whose care needs are primarily driven by a health condition, whether that stems from illness, disability, or accident. The critical distinction is financial: if you qualify for CHC, the NHS pays 100% of your care costs. If you don’t qualify, your care falls under local authority social services, which is means-tested, meaning you may have to pay some or all of the cost yourself depending on your savings and assets.
Eligibility has nothing to do with a specific diagnosis. Someone with dementia, a spinal cord injury, or a neurological condition could qualify, but only if their overall care needs meet the threshold for what’s called a “primary health need.” Two people with the same condition can have different outcomes depending on how complex, intense, and unpredictable their individual needs are.
How the Assessment Works
Getting assessed for NHS Continuing Healthcare is a structured process. A multidisciplinary team of at least two healthcare professionals from different disciplines evaluates your needs across 12 specific domains:
- Breathing
- Nutrition (food and drink)
- Continence
- Skin and tissue viability (including wounds and ulcers)
- Mobility
- Communication
- Psychological and emotional needs
- Cognition (understanding)
- Behaviour
- Drug therapies and medication
- Altered states of consciousness
- Other significant care needs
Each domain is scored on a scale from “no needs” up through “low,” “moderate,” “high,” “severe,” and “priority.” The scoring thresholds give a general guide to eligibility: if you have at least one priority-level need, or severe needs in two or more areas, you can typically expect to qualify. You may also qualify with one severe need plus several other needs, or with a combination of high and moderate needs, depending on how they interact. The team considers the full picture, including how unpredictable your needs are and what risks arise if the right care isn’t delivered at the right time.
What Happens if You’re Turned Down
If you’re assessed as not eligible for NHS Continuing Healthcare, you have the right to appeal. The process moves through up to three stages. First, you must lodge a written appeal with your local CHC team within six months of receiving the decision. The team will acknowledge it within five working days and send you a form to fill out within two weeks.
Stage one is a Local Resolution Meeting, an informal discussion between you (or your representative) and a case manager, which should happen within 10 working days of your completed appeal form being received. If that doesn’t resolve the issue, stage two is a Local Resolution Panel, convened within three months of the original appeal date. You’ll receive the panel’s written outcome within four weeks of the meeting. If you still disagree, stage three is an Independent Review through NHS England, which you must request in writing within six months of the stage two outcome.
Appeals are worth pursuing. The assessment process involves subjective judgment across multiple domains, and initial decisions are sometimes overturned when additional evidence is presented or when scoring is reconsidered.
Which CHC Applies to You
If you’re in the United States and encountered “CHC” in the context of a local clinic, insurance paperwork, or community health services, it almost certainly refers to a Community Health Center. These are brick-and-mortar facilities where you go for primary care, and you can search for one near you through HRSA’s online finder.
If you’re in England and came across “CHC” in connection with long-term care planning, a hospital discharge, or care home funding, it refers to NHS Continuing Healthcare. This is especially relevant if you or a family member has complex medical needs and you’re trying to understand who pays for ongoing care. The financial stakes are significant: qualifying for CHC can save tens of thousands of pounds per year in care home fees that would otherwise come out of pocket.