CEE Proposes New Financing System to Expand Use of School-Based Health Centers

Earlier today, CEE released a new report, Supporting Learning through Better Health: A Strategy to Ensure Adequate and Stable Funding for School-Based Health Centers in New York State, which outlines a financing strategy that would promote the expansion of school-based health centers (SBHCs) throughout New York.

SBHCs provide valuable medical, mental health, and other reproductive services within the school building where students can readily access them. Studies have shown that these centers can substantially improve both health and academic outcomes, especially for students from low-income families and communities. New York has, until recently, been more supportive of SBHCs than most states. Still, only 5% of New York schools currently have one.

This low percentage of existing SBHCs is largely due to the financial risk that schools and health agencies take in running them, as a result of current financing schemes. Most students in the schools that can benefit the most from having a SBHC are eligible for Medicaid and Child Health Plus funding, but federal and state regulations are written for hospitals, not schools, and this makes it difficult for SBHCs to obtain reimbursement for many of the services they provide.

Making things worse, Governor Cuomo and the New York State Department of Health are currently pressing to move SBHCs into the state’s Medicaid managed care system, from which they had previously been exempt. This transition would dramatically reduce revenues for SBHCs, which would likely lead to service cutbacks, and, ultimately, the demise of many SBHCs, most severely affecting underserved low-income communities.

The CEE report advances a financing strategy that would fill the gap between the insufficient revenues that SBHCs now receive and their actual operating costs. The Campaign proposes that the state guarantee each SBHC a reasonable annual per-student rate that covers the actual cost of efficiently providing necessary and required health services. The state would then be reimbursed by Medicaid and private insurers for most of these costs.

Our approach provides adequate, stable funding for existing SBHCs through a mechanism that involves no additional per-student costs to the state. In fact, by maximizing federal reimbursements, this system would result in a reduction in the percentage of SBHC costs that the state is now paying. The assurance of adequate and stable funding should lead to a strong growth in the number of SBHCs, resulting in improved delivery of health services and greater school success for students from low-income households.

In response to the report, Dr. David Appel, Director of the School Health Program, Albert Einstein School of Medicine, Montefiore Hospital, said, “The Campaign for Educational Equity is proposing an insightful and feasible plan that could dramatically change the nature of funding for School Based Health Centers — and thereby improve the health and the education of hundreds of thousands of New York City’s school children.”

Charles E. Basch, Richard March Hoe Professor of Health and Education at Teachers College, Columbia University, also stated: “Providing a stable funding system for SBHCs that have a strategic focus on eliminating health barriers to learning can substantially help reduce  health and educational disparities among America’s most vulnerable youth.”


Michael A. Rebell, executive director of the Campaign for Educational Equity, was the prime author of the report, with editorial assistance from Jessica R. Wolff, CEE’s policy director and research assistance from Linda Moon. Funding to support this research was provided by the James and Judith K. Dimon Foundation. The report does not necessarily reflect the views of Teachers College, its trustees, administrators, or other faculty.

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