Policy Priorities

2017 Policy Priority Areas

Note: The following policy priorities are also available in a downloadable PDF.

Repeal of the Affordable Care Act

We are deeply concerned about proposals to repeal the Affordable Care Act (ACA), particularly without a comprehensive replacement in place that ensures coverage for those currently covered under the ACA. The number of uninsured children would more than double under a partial repeal of the ACA.

Talking Points

  • Repealing the ACA would cause 32 million people to lose coverage by 2026 and roughly double premiums in the individual insurance market (Congressional Budget Office).
  • Repealing the Medicaid expansion would eliminate health coverage for up to, and quite possibly more than, 11 million low-income Americans in the 31 states (plus the District of Columbia) that have taken up this option (Center on Budget and Policy Priorities).
  • The number of uninsured children would more than double under a partial repeal of the ACA: an additional 4.4 million children ages 18 and younger would become uninsured by 2019.
  • The percent of uninsured children would rise to 9.6 percent under a partial repeal of the ACA– more than twice as high as the current law projects for 2019 (4.1 percent). Currently, children’s coverage rates are at a record high of 95 percent. (Georgetown Center for Children and Families/Urban Institute)
Community Health Center Program (Section 330, Public Health Service Act)

We support extending the mandatory Community Health Center Fund past fiscal year (FY) 2017 to avert any cuts to program funding. Community health centers (CHC), also known as federal qualified health centers (FQHC), are often considered “safety net providers” because they serve inner-city and rural areas that typically don’t have access to large hospitals or doctors’ offices, and because they treat all patients, regardless of their ability to pay. Robust funding for FQHCs is critical to the future of school-based health centers (SBHC). More than 40% of SBHCs in the U.S. are sponsored by FQHCs and benefit from federal funding.

Talking Points

  • The CHC program is currently financed through a combination of discretionary and mandatory federal funds.
  • A mandatory fund was established under the Affordable Care Act, which provided a major investment of $11 billion over a five-year period for the operation, expansion, and construction of health centers throughout the nation. In 2015, Congress extended the Community Health Center Fund assuring health centers a continued source of mandatory funding of $3.6 billion annually for two additional years (FY16 and FY17).
  • This extension temporarily averted what was known as the “Primary Care Cliff” which would have ended mandatory funding—resulting in a 70% cutback in program funding.
  • If mandatory funds are not extended and/or discretionary funds not significantly increased past FY17 (which ends September 30) CHCs—and SBHCs sponsored by them—will face devastating cuts.
  • According to the School-Based Health Alliance’s 2013-2014 Census Survey, more than 40% of SBHCs are sponsored by FQHCs that receive federal funds from the CHC program.
Future of the Children’s Health Insurance Program (CHIP)

We support timely reauthorization of CHIP that includes: (1) a robust level of funding and (2) ensures strong protections and benefits to covered children. Together, Medicaid and CHIP cover 40% of kids in the U.S and a majority of the children seen in school-based health centers (SBHC).

Talking Points

  • Funding for CHIP expired on September 30, 2017. Congress must act immediately to extend funding.
  • CHIP is an important source of coverage for 8 million children from low to moderate income families.
  • Together, Medicaid and CHIP cover 40% of kids in the U.S and a majority of the children seen in SBHCs.
  • Like the Medicaid program, CHIP is a state/federal match program; however the federal CHIP match rate is higher and the program is capped.
  • States have flexibility in how to implement their CHIP program. Some states have a separate CHIP program, some use CHIP funds to expand their Medicaid program, and some adopt a combination approach.
  • A Republican-controlled Congress may push for less federal money going into the CHIP program and more flexibility on how states spend the money they receive. This effectively translates into fewer protections for children.
  • Congress should reauthorize CHIP in a timely manner. States need time to prepare their budgets.
  • Congressional inaction on CHIP would be devastating for children were it to follow a repeal of the Affordable Care Act as there would be no marketplace coverage for children to fallback upon.
Preserving Medicaid

We oppose any changes to Medicaid financing which threaten access to care for children and adolescents, including block grants or “per capita caps”. The majority of children and adolescents served in school-based health centers (SBHC) are covered by Medicaid and the Children’s Health Insurance Program (CHIP).

Talking Points

  • Reforming Medicaid into a state block grant puts a cap on the federal share of funding, with states left to figure out how to spend much more limited dollars.
  • Under this scenario, it would be nearly impossible for states to maintain the same benefit and eligibility levels through a block grant.
  • A “per capita cap” means the federal government would pay up to a fixed amount per beneficiary. If actual state Medicaid costs per beneficiary exceed the cap, states would be responsible for all remaining costs.
  • States may drop benefits that federal law currently requires states to cover and curtail or end eligibility for certain populations. For example, children in some states could lose access to EPSDT (Early Periodic Screening, Diagnostic, and Treatment)—the comprehensive pediatric benefit that federal law now requires. EPSDT includes preventive, dental, mental health, and developmental services. It is a core function of SBHCs.
  • Children and adolescents comprise half of Medicaid beneficiaries.
  • The majority of children and adolescents served in SBHCs are covered by Medicaid and CHIP.
Hallways to Health Act (H.R.1027/S.356)

We support the Hallways to Health Act, a comprehensive school-based health care bill that was re-introduced in the 115th Congress and would provide federal support for high-quality comprehensive health care and mental health services to students at school-based health centers (SBHCs) across the country.

We will strategically seek opportunities to advance components of the bill through larger health care legislative vehicles, such as the reauthorization of the Children’s Health Insurance Program (CHIP) or telemedicine legislation.

Please access a section-by-section analysis of the bill here.

Key Components of the Bill

  • Ensures that all public health insurance programs reimburse SBHC providers for services covered by Medicaid and CHIP.
  • Authorizes grant programs to expand the utilization of community health workers and telehealth services.
  • Designates SBHCs as federal safety net and essential community providers.
  • Makes several technical improvements to the School-Based Health Center authorization that was included in the Affordable Care Act but never funded.
  • Provides support for state-based technical assistance to improve care in medically underserved areas.
  • Children and adolescents comprise half of Medicaid beneficiaries.
  • More than 2,300 SBHCs exist in 49 states and the District of Columbia. SBHCs are critical access points that provide comprehensive care to children and adolescents in schools, including primary care, behavioral and oral health services, and prevention and early intervention.

General Public Policy Priorities

Advance federal and state policies that develop, enhance, and support the role of SBHCs as safety net providers for children and adolescents
More Information
Because of the vital role they play in serving low-income and medically underserved populations, SBHCs are an important part of the nation’s health care safety net for children and adolescents. We advocate for a federal appropriation of the current authorization that funds SBHCs under the federal safety net and provides protections of the Public Health Service Act, including cost-based reimbursement, access to low-cost drugs, and tort protection. In addition, we support the inclusion of SBHCs as essential community providers in federal and state health insurance exchanges and the removal of barriers to Medicaid reimbursement, including prior authorization requirements.

We also strongly support passage of The Hallways to Health Act (H.R. 4621/S. 2590). Introduced in the 114th Congress, this legislation would increase access to health care through SBHCs, incorporate community health workers and telehealth services in the SBHC model, and provide technical assistance to improve care in medically underserved areas. In addition, the bill would ensure that all public health insurance programs reimburse SBHC providers for services covered by Medicaid and the Children’s Health Insurance Program (CHIP) to ensure the long-term financial stability of these important centers.

Integrate school-based health centers into federal policies that improve student success
More Information
Improving student health is integral to education reform. As reauthorization of the Elementary and Secondary Education Act (ESEA) moves forward, the School-Based Health Alliance will work with our education partners to promote the services provided by SBHCs to best achieve academic success. We seek the inclusion of SBHCs as eligible entities for evidence-based strategies that support children’s academic success, safety, health, and wellbeing.
Support state and local efforts to integrate and elevate SBHCs within health care reform
More Information
State Medicaid programs are redesigning delivery and payment models such as patient-centered medical homes, accountable care organizations, bundled payments and other innovative financing and delivery strategies to achieve the triple aim of higher quality and improved outcomes at a sustainable cost. We are working closely with key health care stakeholders in four states to support them in the development and execution of mutual goals for improving quality and outcomes for children while maximizing existing resources.