Research Objective: This study identifies gaps in the public safety net by examining the placement of community health centers (CHCs) and the delivery of maternal and child health services. Maternal and child health services were selected as our indicator because of the direct effect they have on infant mortality. Low infant mortality is an indicator of good population health status and access to primary care.

Study Design: We obtained the Health Care Service Delivery Site dataset from the Health Resources and Service Administration website (HRSA). This dataset contained the locations of all FQHCs and FQHCs lookalike health centers in the U.S. GIS shape files of local health department jurisdictions were obtained from the National Association of County and City Health Officials (NACCHO). Information from the HRSA dataset were merged with the GIS shape files to create a visual representation of the locations and number of community health centers within local health department jurisdictional areas. We then used the 2008 NACCHO National Profile Study to examine the provision of prenatal care services and maternal and child health home visits as reported by local health departments. These measures were selected because community health centers and many local health departments provide clinical and public health services to uninsured and underinsured women and children in their jurisdiction.

Population Studied: This study focuses on five states in the Great Lakes region of the Midwest United States. These states are Illinois, Indiana, Ohio, Michigan, and Wisconsin. Within this region, there are 1109 community health center locations (HRSA). These locations are distributed among clinics, schools, correctional facilities, hospitals, and nursing homes.

Principal Findings: From our GIS analysis of the distribution of services in the Great Lakes region, we found that the greatest concentration of community health centers are within urban areas; however, these entities are not present in many rural jurisdictions. Of the five states, the state of Michigan shows the largest concentration of community health clinics per 100,000individuals within local health department jurisdictions while the state of Indiana shows the least amount of community health centers. Many areas throughout the Great Lakes region do not provide prenatal care services and a community health center is not present. A greater number of health departments provide maternal and child health home visits; however, there are still areas in which gaps exist.

Conclusions: This article focuses primarily on CHCs and LHDs within the safety net because of the leading roles these governmental agencies play in providing services to the low-income and uninsured. This study is important because it shows the potential gaps in the public safety net in maternal and child health. It is necessary to identify these gaps in order to improve delivery of services to these areas. Although this study focuses on the Great Lakes region of the country, it is expected that the safety net nationwide shows a similar pattern.

Implications for Policy, Delivery, or Practice: The passage of the PPACA creates the opportunity for more individuals and families to obtain services from public health system providers, thus having a major impact on the manner in which safety net providers work together. The ability of the safety net providers to operate successfully within the current funding environment will hinge on how efficiently resources are used to produce desired services and outcomes.