The centers, financed through state and federal dollars, patient payments and private grants and contributions, provide a stable source of health care to the uninsured as well as Medicaid recipients.
In many of these clinics doctors and nurses are stretched to the limit, this too, coupled with lack of proper equipment. Accordingly, tens of thousands of patients sometimes wait weeks for appointments or find themselves in crowded waiting rooms, or have to linger for days before getting an answer to a medical question. Even simple procedures are impossible at some ill-equipped clinics.
Finding the money to keep up with demand has been daunting, and clinic managers speak of the constant strain to care for the growing numbers of uninsured.
Says Sabrina Williams, medical director at Citizens Health Center in Indianapolis: "We're feeling a bit overwhelmed. We're trying to do everything we can to provide patients with what they need, but we're not getting what we need. Our resources are strained."
Since 2002, the number of patients using the centers in Indiana has grown by almost 50 percent, from about 118,000 to close to 176,000 in 2006. The number of centers has climbed from 10 to 16.
The Bush administration and Congress have doubled the annual budget line for these health centers to about $2 billion since 2000. At the state level, funding has increased by about 32 percent, from $8.4 million in 2002 to $11.1 million in 2006.
Yet, it is a fact that the priority has been to allocate that money toward establishing new centers in mostly poor, rural counties, not expanding existing centers in the cities.
As a result, state and federal funding has not increased for many of Marion County's 10 federally qualified health centers.
Meanwhile, the uninsured population continues to balloon statewide (from 674,000 in 2000 to more than 871,000 in 2005). Nearly half (more than 82,000) of the patients seen at Indiana's federally qualified health centers in 2006 were uninsured.
"Funding definitely hasn't kept up," says Indiana Sen. Vi Simpson. "Until a couple of years ago, there hasn't been a whole lot of interest in providing medical services to the uninsured."
This year, lawmakers are taking steps to help. Both the House and Senate have proposed $35 million to $40 million in additional funding for existing facilities nationwide in fiscal 2008.
Indiana lawmakers also added $15 million to next year's budget for more than 40 state-funded health centers, including the 16 that received federal dollars.
Health center leaders say they're grateful for the extra money but need still more to reach the 14 percent of the state's population that is uninsured.
To help fill the gap, they are stepping up their private fundraising efforts.Take for example, the HealthNet company. The company purchased a building to replace its cramped Southwest Health Center and is searching for another building to move its People's Health & Dental Health Center, which also is too small. To finance these moves, the group plans to launch an $8 million fundraising campaign.
"It takes more money for us to provide those services," Thomas said. "That's an ongoing struggle for us."