Integrating Chiropractic Care into Federally Qualified Health Centers: Policy,Payment,and Pathways for Sustainable Spine and Musculoskeletal Care

Abstract

Background:

Federally Qualified Health Centers (FQHCs) deliver comprehensive primary care and supportive services to underserved populations. However, current care models have been unable to meet demand for spinal and musculoskeletal (MSK) care, a leading cause of disability and driver of opioid prescribing.

Purpose:

Chiropractors are well positioned to help FQHCs manage the burden of acute and chronic spinal and MSK pain, supporting primary care providers while expanding access to nonpharmacologic treatment. Yet integration of chiropractic services into FQHCs remains limited.

Discussion:

Although chiropractors are eligible to provide qualifying Medicare Prospective Payment System visits in FQHCs, chiropractic adoption appears to be enabled primarily by Medicaid coverage, with integration concentrated in states that reimburse chiropractic services and where approximately 50% of chiropractic FQHC patients have Medicaid coverage. This article examines the financing and policy environment shaping chiropractic integration in FQHCs, compares fee-for-service and value-based payment models, and explores alternative pathways, including shared savings, capitation, and grant funding. Drawing on parallels to successful integration from dentistry, podiatry, and optometry, we describe how chiropractors can function as embedded spinal and MSK specialists contributing to quality and cost outcomes.

Conclusion:

We argue that with supportive Medicaid and Medicare policies, chiropractic services can improve pain outcomes for spinal and MSK disorders while reducing downstream health care utilization in safety-net settings.