School-Based Health Centers: Available Information on Federal Funding

Many of our nation's children have difficulty accessing needed health care services. In 2008, the Robert Wood Johnson Foundation reported that about 25 percent of children with insurance and about 55 percent of uninsured children did not receive a recommended routine checkup within the previous year. According to the Department of Health and Human Services (HHS), children face growing risks from chronic physical conditions such as asthma and obesity and from mental health disorders such as depression, and yet, as we have reported, their access to services may be impeded by a number of barriers, including a lack of health insurance and a lack of convenient transportation to medical appointments. Access to mental health care services may also be impeded by concerns about stigma--negative attitudes and beliefs often associated with receiving such care--which can be a deterrent to seeking these services. To help increase children's access to primary health care and other health care services, states and communities have established school-based health centers (SBHC). SBHCs are located on school grounds, provide health care services regardless of ability to pay, and offer a broader range of services than a school nurse generally provides. Almost all SBHCs provide primary care, and they vary in the extent to which they provide other health care services, such as immunizations, behavioral health care, oral health care, health and nutrition education, and reproductive health care. SBHCs improve children's access to health care services by reducing financial and other barriers to care, especially for children who are poor or uninsured. For example, as we reported in our July 2009 report on children's access to mental health care services following Hurricane Katrina, SBHCs in Louisiana have emerged as a key approach to providing access to primary health care and mental health care services. Although the principal sources of financing for SBHCs overall are state, local, and private funds, some federal program funds have been used by SBHCs to provide health care services to school-aged children. The three key sources of federal grant funds are HHS's Health Center Program, Title X Family Planning program, and Maternal and Child Health (MCH) Services Title V Block Grant program. In addition to receiving grant funding through grantees of these programs, SBHCs may bill Medicaid for certain services provided to children enrolled in Medicaid. SBHCs may also bill private insurance and other types of public programs for covered services, such as the State Children's Health Insurance Program (CHIP). The Patient Protection and Affordable Care Act (PPACA) appropriated additional federal funding for SBHCs. This funding is to be made available through a program established specifically to fund equipment and facilities. HHS also provides partial funding for a biennial survey of SBHCs that is conducted by the National Assembly on School-Based Health Care (NASBHC)--a private nonprofit organization that advocates on behalf of SBHCs. The survey for the 2007-2008 school year was made available to the 1,909 SBHCs in NASBHC's database and included information such as the services SBHCs provided, the types of organizations that sponsored them, the sources of grant funds they received, and the types of insurance they billed. The Health Care Safety Net Act of 2008 required that we study the economic costs and benefits of SBHCs. However, we informed cognizant committee staff that data on economic costs and benefits were unavailable. In this report, we describe (1) what is known about federal grant funds received by SBHCs, and (2) what is known about Medicaid reimbursements received by SBHCs.