Assessing the Effectiveness of Policies to Improve Access to Primary Care for Underserved Populations: A Case Study Analysis of Baltimore City, Maryland

Multipayer Primary Care Network
Focus Area:
Primary Care Transformation
Health Equity

Funding for this project was provided by the National Institute for Health Care Reform. Read a related report reviewing the evidence on the effectiveness of these policies.


This case study of Baltimore City, Maryland,* is the second in a series of case studies designed to assess the effectiveness of various policy initiatives to expand access to primary care in a region, particularly for underserved populations. Several parts of the city are classified as primary care health professional shortage areas, and many policy initiatives have been implemented to make primary care more accessible, but barriers persist.

For example, Baltimore has a significant number of physicians, but not enough of them provide primary care to low-income and Medicaid-eligible populations in the city. State programs to attract more providers to serve underserved areas and populations have been helpful, but the scale of the programs has been too small to move the needle. Federally qualified health centers (FQHCs) are a critical safety net provider in the city and have benefited from many state-level policy decisions, but school-based health centers (SBHCs) in the city have struggled to expand because of a lack of funding and significant regulatory burdens.

While efforts to improve access to primary care through telehealth are underway, barriers like lack of broadband access or lack of smartphones persist for some subpopulations. Despite several efforts by providers to connect patients with transportation options for primary care, transportation remains one of the biggest barriers to primary care access. The state has made significant strides in making primary care affordable by supporting policies that expand health insurance coverage and affordability. However, the inability of undocumented immigrants to enroll in subsidized health insurance remains a major gap.

The state’s innovative Total Cost of Care model and the Maryland Primary Care Program have the long-term potential to improve primary care access in Baltimore, but local stakeholders expressed a need for more local input in designing incentives for further investment in primary care. Local stakeholders also expressed frustration at not having the funding to establish a local forum for planning and implementation of a broad primary care strategy for the city.

*Baltimore City is separate from Baltimore County; wherever Baltimore is mentioned in this case study, the authors are referring to Baltimore City and not Baltimore County.




Kona M,  Houston M, Clark J, and Walsh-Alker E. Assessing the Effectiveness of Policies to Improve Access to Primary Care for Underserved Populations: A Case Study Analysis of Baltimore City, Maryland. Milbank Memorial Fund. August 15, 2022.

 Case Study

 Back to Publications