Figure 1
STATE, THIRD PARTY AND FEDERAL SUPPORT FOR SCHOOL-BASED HEALTH CENTERS, 1997-98
In millions

State General Fund
$29.6

MCH Block Grant
$9.3
Third Party
Est. Fee-for-service Medicaid   8.2
Est. Medicaid managed care     .7
Est. Commercial                      .5
Total
$9.4
Other state support
$7.2

Federal Healthy Schools/
Healthy Communities
$8.0*
*FY 1999 program funding

Source: National Survey of School-Based Health Centers, 1997-98, Making the Grade, The George Washington University, Washington, D.C.

Figure 2
LOCAL FUNDING FOR SCHOOL-BASED HEALTH CENTERS IN 4 COMMUNITIES, 1996-97

Community
Dallas
Denver
Portland,
OR
Seattle

# of SBHCs
10
12
12
8

Total
Operating
Budget
$4.0m
$2m
$3.4m
$1.4m

% support
from city/
county
87%
57%
73%
98%
Source: Access to Comprehensive School-Based Health Services for Children and Youth; Spring 1998, Making the Grade, The George Washington University, Washington, D.C.
Financing strategies create engine for growth
The growth of school-based health centers has been fueled by the increasing investments from state and, in some instances, local governments, as well as rising patient care reimbursements from Medicaid and commercial insurers.

Federal support
Federal funds have helped support centers primarily through two avenues: the Maternal and Child Health (MCH) Block Grant program, in which states determine how their money is spent; and a direct grant program called Healthy Schools/Healthy Communities which in fiscal year 1999, will provide $8 million to support some 40 centers across the country. (Figure 1)

State support
State general fund support tops $29 million with 21 states allocating some general fund dollars to school-based health centers. The leading funders are New York, Connecticut, Delaware, and Louisiana. In addition, during school year 1997-98, states directed more than $9 million from their MCH block grants to centers. New York ($4m), Texas ($1.4m) and Minnesota ($1.3m) led the way in allocations. (Figure 1)

Patient care revenue
Third party revenues, especially from Medicaid, are a growing source of support for school-based health centers. In 1997-98, 15 states reported making $8.2 million in payments to centers from Medicaid fee-for-service billing; five states reported nearly $700,00 from Medicaid managed care to school-based health centers, and seven states reported $485,000 from commercial insurers to the centers.

Local dollars
While no national tally is available, city and county funds are a growing source of support for centers. In 1995, for example, local dollars supplied 46% of the total budgets of 11 cities’ school-based health center programs. In 1996-97, four communities reported even greater levels of support from local funding. (Figure 2)

 

Figure 3
STATE POLICIES TO SUPPORT SCHOOL-BASED HEALTH CENTERS*

Yes No

State office charged with supporting SBHCs
24
22

State law permits NPs to join managed care provider networks as primary care providers
40
5

State has operating standards for SBHCs
23
23

State licenses SBHCs
7
39
Source: National Survey of School-Based Health Centers, 1997-98, Making the Grade, The George Washington University, Washington, D.C.

*Data drawn from the 45 states plus the District of Coumbia in which the SBHCs are located.

Figure 4
STATE FINANCIAL POLICIES TO SUPPORT SCHOOL-BASED HEALTH CENTERS*

Yes
No

SBHCs may participate in Medicaid
43
3

SBHCs may participate
in Child Health Insurance Program
39
4

State has taken specific measures to encourage SBHC participation in managed care
28
18

SBHCs may participate in managed care as Primary Care Providers
35
10

SBHCs or institutional sponsors have contracts with health plans
22
23
Source: National Survey of School-Based Health Centers, 1997-98, Making the Grade, The George Washington University, Washington, D.C.

*Data drawn from the 45 states plus the District of Coumbia in which the SBHCs are located.

Foundation grants
Private foundations have played a critical role in the growth of school-based health centers. The Robert Wood Johnson Foundation launched early efforts to develop the model nationally. Recently, community and regional foundations as well as the national W.K. Kellogg Foundation have joined efforts to sponsor school-based health centers. State policies create a favorable clinical
and financial environment

School-based health centers are increasingly becoming a part of mainstream health care. This integration reflects growing recognition that centers can meet the highest standards of clinical practice. To support high quality care, many states have created offices to develop clinical guidelines and operating standards for school-based health centers, as well as provide them with technical assistance. Seven states require centers to secure operating licenses from the state. (Figure 3)

Because state support does not fully fund school-based health centers, most states allow and even encourage centers to bill Medicaid and commercial insurers for patient care, leaving state grants to pay for uninsured students and those services that are not covered by insurance. With greater emphasis on patient billing, more centers are participating in managed care. Some states have actively encouraged this participation by brokering arrangements between managed care plans and school-based health centers. (Figure 4)