SBHC Financing

Most SBHCs finance their operations through a diversity of funded sources from by federal, state and local public sector grants, foundations, patient revenue, private/corporate support, and in-kind contributions from school and community agency partners. According to a national survey of SBHCs, the most common sources of grant funding are: state government (65%), private foundation (49%), county/city government (33%), corporate (29%), and federal government (28%). Eighty percent of SBHCs bill students’ health insurance.

Positions and Priorities
SBHC Funding
SBHC Financing

Positions and Priorities

Policy Statements

Medicaid and School-Based Health Centers - Medicaid is a critical source of funding for SBHCs and is a key component towards their long-term fiscal stability. Yet, barriers to Medicaid reimbursement exist for too many SBHCs, and this important source of revenue is often not fully realized.

SBHC Financing Options

Financing Documents

Federal Government
"Assessing National Opportunities to Sustain School-Based Health Centers" details various federal grant programs that currently support, or have the potential to support, school-based health centers, including primary care, health promotion, reproductive health, maternal and child health, social services and education.

State Government
A number of state governments support school-based health centers with funding and technical assistance. This presentation highlights findings from NASBHC's 2005 policy and funding survey of all state health departments and Medicaid agencies.

Public Health Insurance
"Partners in Access: School-Based Health Centers and Medicaid" is a technical report on state Medicaid policies and practices that support reimbursement to school-based health centers. Sixteen policies from seven states (CT, IL, MD, MI, NC, NM, and NY) are included in the report's appendix.

Medicaid Resources

In seeking a diverse array of public and private funding sources to implement, sustain, and expand school-based health centers, communities have increasingly come to regard public health insurance programs (Medicaid and SCHIP) as essential to the school-based health center’s financing strategy. NASBHC has gathered articles, resources and tools that describe how public health insurance programs support SBHC financing.

Partners in Access: School-Based Health Centers and Medicaid

Lessons from Policy and Practice
Summary of regional meetings with SBHC administrators, state health department policy makers and federal and state Medicaid representatives. Policies and practices from the field are included.

View letter to Medicaid Directors

Medicaid, School Health and School-Based Health Centers
NASBHC Executive Director John Schlitt made this presentation to US Senate staff at a September 2005 briefing on Medicaid and school health services in September.

Opportunities to Use Medicaid in Support of SBHCs, June 2002
Medicaid expert Vernon K. Smith authored this resource to assist State and local health officials who would like to ensure that School-Based Health Centers (SBHCs) are appropriately reimbursed for comprehensive primary care and other covered health care services that they provide to Medicaid beneficiaries.

Reimbursement Models for SBHCs Under Managed Care
Four models for SBHC reimbursement under managed care are described in these slides from the Center for Health Services Research and Policy. Approaches include: A) SBHC out of MCO network; B) MCO pays out-of-network SBHC; C) Contract requirement or voluntary arrangement to include SBHC in provider network; and D) SBHC paid by PCP.

SBHC purchasing specifications for Medicaid and CHIP managed care
This technical assistance document from George Washington University Center for Health Services Research and Policy was developed to assist interested state officials, at their option, in purchasing SBHC services from managed care organizations (MCOs) under risk contracts on behalf of children who are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP).

No Statutory Basis for Medicaid’s Free Care Policy Argues Advocate
National health care financing expert Andy Schneider advises NASBHC that free care policy lacks legal standing.

Patient Revenue

The issue briefs below - oldies but goodies - document NASBHC's significant body of work of advancing policy and practice issues related to capturing patient revenue, considered critical to many as a means of financial sustainability for school-based health centers (SBHCs).

School-Based Health Center Third-Party Billing: Policies and Systems (2002)
Recommendations from 2002 work group on policies and capacity needs to support billing in SBHCs.

Critical Issues in School-Based Health Care Financing (1999)
Describes critical issures regarding the long term sustainability of SBHCs. This paper summarizes the discussions that were shaped to 1) identify the various mechanisms for financing school-based health care; 2) explore challenges in utilizing those resources as long-term funding sources; and 3) outline future opportunities for creating a sustainable national network of SBHCs.

Medicaid Reimbursement in School-Based Health Centers: State Association and Provider Perspectives (2000)
Describes the role Medicaid revenue plays in supporting school-based health care operations. Thirteen state associations, representing 674 SBHCs (more than half the field) and an estimated 465,000 enrollees, described their collective experiences. An additional 40 programs running 129 school-based health centers completed the provider survey.

Determining A Policy Agenda to Sustain School-Based Health Centers: NASBHC Assesses the Health Care Safety Net Environment (2000)
Representatives from health care institutions, including local public health departments, hospitals, community health centers, and public health corporations, to explore current challenges to the health care safety net and their implications for SBHCs. How does school-based health care fit within the emerging systems changes and reforms that will affect the vitality of safety net providers? Does there continue to be value in population-specific access programs that blend public health, personal health care, pupil support and classroom education? Where will the financial support come from?