Trends in Days in Accounts Receivables Across Safety-Net Health Centers, 2019-2023

Community-based health centers play a crucial role in delivering care to medically under-resourced communities but operate in a state of financial instability exacerbated by the COVID-19 pandemic. To improve understanding of the pandemic on health centers we assessed monthly and annual accounts receivables (AR) data over 5 years (2019-2023) for 81 health centers. Between 2019 and 2023, health centers improved their Days in AR, decreasing from 49.8 in 2019 to 47.5 in 2023, demonstrating financial resilience in the face of a challenging environment. Larger health centers demonstrated the greatest reduction in days in AR, whereas health centers with a lower percentage of uninsured patients experienced an increase in AR. Clinics operating in Medicaid expansion states were largely stable, while clinics in non-expansion states had higher AR through fall 2020, a sharp decrease in early 2021, and then stayed stable throughout the rest of the study period.