Data from Making the Grade's most recent survey of state initiatives to support school-based health centers (SBHCs) reveal that 900 centers provided care to children during the 1995-96 school year. This represents a fifty percent increase over the previous Making the Grade survey conducted two years earlier.

State Support Remains Key

State governments continue to provide substantial funding for the centers. During 1995-96, 34 states allocated $41.9 million in state and federal block grant funds to school-based health centers, an eight percent increase over 1994. Fifty-four percent of all school-based health centers received some state-directed funding. This means that for every two SBHCs, one is receiving some degree of state support.

The portion of the center budgets supported by state-directed dollars varies greatly. Twelve states supported at least 75 percent of their centers and of those, four states supplied over 90 percent of the total funds needed to run those centers. Five states reported that fewer than half of their centers receive any state-directed funds, and ten states provided no state-directed funding at all.

The primary sources of state-directed support are Title V of the Social Security Act (Maternal Child Health Block Grants) and state categorical funds. Other sources of federal support include the Social Security Block Grant, the Preventive Health Block Grant, and Drug Free Schools and Communities Act. Most states have not tracked financial support available through Medicaid reimbursement but patient care revenues from a variety of payers, including Medicaid, appear to be an increasing source of funding.

Five states account for nearly three-fourths of the $13 million in Title V moneys: Georgia, Illinois, Louisiana, New York, and Texas. Six states account for over 80% of the $27.7 million in state revenues,: Arizona, Connecticut, Delaware, Florida, Massachusetts, Michigan, and New York.

Centers Spread South and West

Two years ago more than half of all SBHCs were located in the Northeastern and Mid-Atlantic states. Recent growth in Florida, Texas and Arizona has reduced that proportion to 42 percent. The growth outside the Northeast indicates the national appeal of this model. In school year 1995-96, school-based health centers were distributed as follows: Mid-Atlantic states and New England -- 380; Southeast and South-central states -- 171; Midwest -- 109; Southwestern and Rocky Mountain states -- 164, and Pacific coast states/Hawaii -- 76.

As the map indicates, school-based health centers are found in 43 states plus the District of Columbia. The ten states reporting the largest number of centers include New York, Florida, Texas, Connecticut, Pennsylvania, Maryland, California, Massachusetts, Michigan, and Arizona.

As states with significant efforts to improve rural health become involved in school-based health care, the number of rural schools offering primary care services has expanded. School-based health center programs in West Virginia, North Carolina and Louisiana have contributed particularly to the increased presence of SBHCs in rural areas.

School-based health centers continue to be located in all types of schools. While high schools continue to be the primary site of SBHCs at 41 percent of all centers, elementary schools now house 32 percent of the centers and middle schools, 17 percent of the centers. Four percent of the centers are located in comprehensive K - 12 schools, and six percent were located in other types of schools, including alternative schools, K - middle school, and Head Start programs. Compared to two years ago, a larger proportion of the centers are serving elementary and middle school students -- increasing the importance of health promotion and preventive services.