New Jersey has one community health center site for every 13,313 foreign-born residents — where the immigrant safety net is thinnest

Where the immigrant health safety net is thinnest

The finding: federally funded community health centers — the FQHCs — are the health safety net. By federal rule they serve everyone on a sliding fee scale regardless of ability to pay, and whether or not they carry insurance. HRSA reports they served more than 32.4 million people in 2024, about 90% of them at or below 200% of the federal poverty line. For an immigrant family locked out of Medicaid and marketplace subsidies, the local health center is often the only door to primary care.

Join HRSA’s site file to the Census foreign-born population and coverage turns out to run backward from need. The most stretched states:

Nationally there is one community health center site for every 2,537 foreign-born residents. New Jersey — one of the most heavily immigrant states in the country — has one for every 13,313. The best-covered states are small and rural, and their low ratios come from having few immigrants and many small sites, not from better immigrant access: West Virginia shows one site per 60 foreign-born residents. Read the thin end, not the thick end.

Every state, thinnest safety net first

Foreign-born residents for each community health center (FQHC) site. Site counts are from HRSA's site-level file (2026-07-07); foreign-born population is the ACS 5-year estimate. Marked rows are above the national average of 2,537 per site. Sites serve the whole community — this is an immigrant-load proxy, not a measure of any one immigrant's wait.

Sources: HRSA site file and the Census Bureau ACS. States with the fewest foreign-born residents per site (rural, low-immigrant states) get there mostly by having small immigrant populations and many small sites, not by superior immigrant access. "Foreign-born" includes naturalized citizens.

What the data shows

• The safety net is thinnest where immigrants are most concentrated. New Jersey, Nevada, Delaware, Texas and Florida — high-immigrant states all — carry the most foreign-born residents per site. New Jersey’s 168 sites serve 2,236,554 foreign-born residents; that is the tightest ratio in the country.
• The national baseline is one site per 2,537 immigrants. Half the states sit better than that, half worse; the marked rows in the table above are the worse half.
• The best-covered states are a rural artifact. West Virginia’s one-per-60 and Montana’s one-per-180 reflect small immigrant populations and dense rural health-center networks, not immigrant-specific abundance. This is why the ratio is read from the thin end.
• A site count is not capacity. One large health center can see more patients than several small ones. The ratio is a starting signal about reach, not a verdict on any state’s care.

Why this matters for immigrant families

The people who most depend on a community health center are the uninsured and the low-income — and immigrant families are heavily represented in both, because many are ineligible for Medicaid or for subsidized marketplace coverage regardless of how long they have worked and paid taxes. HRSA’s own numbers make the point: of the 32.4 million people health centers served in 2024, 25.1 million were uninsured or on Medicaid or Medicare. A health center will see a patient on a sliding fee scale, in many languages, without private insurance. Where those sites are spread thinnest across a large immigrant population, that safety net is doing the most work with the least.

If you need care, HRSA’s Find a Health Center tool locates the nearest site by address, and the sites bill on income, not insurance.

Method and caveats

Site counts are the active community health center service delivery and look-alike site records in HRSA’s site-level file, retrieved July 2026. That file lists 18,665 such sites across the 50 states and DC — more than the roughly 16,200 funded-program service sites HRSA headlines, because the site-level file also includes look-alike organizations and every active delivery site. Foreign-born population is the Census Bureau’s American Community Survey 2024 5-year estimate. The ratio is foreign-born residents divided by sites in the state.

Four limits are stated plainly. Sites serve the whole community, not immigrants only, so the ratio is an immigrant-load proxy, not a measure of any one immigrant’s wait. The best-covered states are a rural artifact — small immigrant populations plus dense rural networks, not superior immigrant access. A site count is not a capacity measure. And “foreign-born” includes naturalized citizens, so it is a broad immigrant-population proxy, not a count of the uninsured. Puerto Rico and the territories are excluded because ACS foreign-born is not comparable there.

Download the data: fqhc_access.json — all 50 states and DC, health-center site count, foreign-born population, and residents per site.

Suggested citation: MigrantUSA, “Community health center access by state, 2026,” https://migrantusa.com/datasets/community-health-center-access-by-state/ (accessed [date]).

Embed this widget on your site — free

Newsrooms, clinics, health navigators and immigrant-services organizations: drop in the panel below. It shows the most-stretched states and the national per-site ratio, and updates when we refresh the counts.

<iframe src="https://migrantusa.com/embed/community-health-center-access/" width="100%" height="520"
        style="border:1px solid #e2e8e4;border-radius:8px;max-width:640px"
        title="Community health center access by state" loading="lazy"></iframe>
<p style="font-size:12px">Source: <a href="https://migrantusa.com/datasets/community-health-center-access-by-state/">MigrantUSA — community health center access by state</a></p>