School-Based Health Care State Policy

18 State Governments Commit Resources to SBHCs

Print Friendly

Executive Summary

The School-Based Health Alliance surveys state public health and Medicaid offices periodically to assess state-level public policies and activities that promote the growth and sustainability of school-based health centers (SBHCs). A survey for fiscal year (FY) 2014 found no change in the number of states (18) that reported investments explicitly dedicated to SBHCs since the FY2011 survey. More detailed findings from the survey are provided below or click here to save it in PDF format.

18 State Governments Commit Resources to SBHCs

State Investment in SBHCs

For school year 2013-14, 18 states directed funding totaling $85.1M to 915 SBHCs—a decrease of five percent from 2010-11 (tables 1-2). State general funds represent the largest funding source (80 percent), followed by “other” (14 percent), which includes Social Services Block Grant and Medicaid Match, Title V MCH Block Grant (4 percent), and Tobacco Settlement (2 percent).

Over the last 15 years, the number of state SBHC initiatives has decreased by 51 percent, from 37 to 18. Total state investments in SBHCs, however, have grown 118 percent, despite a challenging state budgetary climate in the most previous years (tables 2-3). Three states (CO, MI, NM) increased their SBHC funding allocation more than threefold (table 4).

State general revenue has consistently comprised the largest proportion of funding for state SBHC programs, increasing from 68 percent of total state funding in FY1996 to 80 percent of total funding in FY2014. The largest decrease in proportion of funding over time is Tobacco Settlement, which declined from 37 percent of total state funding in FY2002 to two percent in FY2014 (table 2).

Policies that Support SBHCs

States that direct funds to SBHCs report holding programs accountable by setting and monitoring standards, requiring certification, and collecting performance data. The SBHC performance indicators most frequently identified by the states include Body Mass Index (BMI) assessment, well child visits, immunizations, and mental health (tables 5-6).

Of the 18 states that fund SBHCs, 13 have enacted meaningful Medicaid policies that assure reimbursement for care delivered to Medicaid enrollees in SBHCs, including primary care prior authorization waivers and mandated managed care organization contracts and/or reimbursement (table 7).


Table 1. State-Directed Funding for SBHCs, by Funding Source

StateSBHCs FundedTotal SBHCs*TotalState General FundTobacco SettlementTitle V MCH Block GrantOther
Total9152315**$85,078,872$68,138,833$1,422,610$3,466,429$12,051,000
AR2124$2,000,000$2,000,000------
CO4755$5,200,000$5,200,000------
CT94111$12,336,716$12,048,716-- $288,000--
DC 66$2,025,000$2,025,000------
DE2929$5,235,300$5,235,300------
IL4160$4,118,117$1,279,000$942,200$845,917$1,051,000
IN236$200,000----$200,000--
LA6470$8,734,531$8,734,531------
MA3452$2,958,292$2,958,292 -- ----
MD7172$2,800,000$2,800,000------
ME1621$699,700$219,130$480,410$160--
MI7090$13,500,000$3,500,000----$10,000,000
NC3273$1,377,664$1,377,664------
NM5272$3,534,100$2,534,100----$1,000,000
NY218229$12,282,352$10,400,000 -- $1,882,352--
OR6565$6,800,000$6,800,000-- ----
TX398$250,000---- $250,000--
WV5097$1,027,100$1,027,100 -- ----

*Data from 2013-2014 National Census
**Total SBHCs nationwide from 2013-2014 National Census, including states that do not fund SBHCs


Table 2. State-Directed Funding for SBHCs, Totals by Source, FY1996-FY2014 (millions)

Table 2. State-Directed Funding for SBHCs, Totals by Source, FY1996-FY2014 (millions)

Table 3. State SBHC Programs, Funding and SBHCs, FY1998-FY2014

 FY1998FY2000FY2005FY2008FY2011FY2014
Total State Dedicated Funds ($M)$38.9$59.9$63.7$83$89.6$85.1
Total # State SBHC Programs373120201818
Total SBHCs Funded by State650700738855875915
Total SBHCs*115713801651190919302315
% state funded56%51%45%45%45%40%

*Data from 2013-2014 National Census


Table 4. States with Ten-plus Years Investment in SBHCs, FY2002, 2008, 2014

StateFY2002FY2008FY2014% Change FY2002-2014
Total$59,102,377$80,890,384$80,603,87236%
CO$375,000$1,699,810$5,200,0001,287%
CT$6,246,505$9,168,186$12,336,71697%
DE$4,646,800$5,400,000$5,235,30013%
IL$3,956,000$4,234,400$4,118,1174%
LA$7,100,000$10,249,823$8,734,53123%
ME$631,376$745,300$699,70018%
MD$3,949,941$2,731,206$2,800,000-29%
MA$5,545,943$3,893,559$2,958,292-47%
MI$2,892,300$10,671,000$13,500,000367%
NM$400,000$3,870,000$3,534,100784%
NY$19,645,000$22,800,000$12,282,352-37%
NC$1,500,000$1,627,000$1,377,664-8%
OR$1,313,512$2,838,000$6,800,000418%
WV$900,000$962,100$1,027,10014%

Table 5.   State Functions to Assure SBHC Accountability

StateState defines SBHCs in law or regulationState requires SBHC certification/ credentialState-funded SBHCs adhere to state operating standards
ARX
COXX
CTX
DC
DEXXX
ILXXX
IN
LAXXX
MAX
MDXX
MEX
MAX
MIXX
NMXX
NYXX
NCX
ORXXX
TXXX
WVX

Table 6. SBHC Performance Indicators Tracked by State Program Office

StateAnnual risk assessmentsImmunization statusDepression ScreeningBMI assessmentPhysical exams/ well child visitsEnrollment as % of student bodyUsers as a % of SBHC enrollees
ARXX
COXXXXXXX
CTXXXXXXX
DCXXXX
DEXXXXXX
ILXXX
INXXX
LAXXXXXX
MAX
MDXXXXXXX
MEXXXXXX
MIXXXXXXX
NCXXXXXXX
NMXXXX
NYXXXXX
ORXXX
TXXXXXX
WV *

*this data was unavailable for FY2014


Table 7.  State Policies Pertaining to Medicaid and SBHCs

Define SBHCs as Provider TypeWaive Preauthorization for SBHCsWaive Preauthorization for Specific SBHC ServicesManaged Care Organizations Required to Reimburse and/or Contract with SBHCs
DelawareIllinoisColoradoDelaware
IllinoisLouisianaConnecticutDistrict of Columbia
IndianaMichiganIndianaIllinois
LouisianaNorth CarolinaMaineMaryland
MaineWest VirginiaMarylandMichigan
New MexicoNew Mexico
North Carolina
West Virginia

Print Friendly

Share