Academic journal article Journal of School Health

The New Child Health Insurance Expansions: How Will School-Based Health Centers Fit In?

Academic journal article Journal of School Health

The New Child Health Insurance Expansions: How Will School-Based Health Centers Fit In?

Article excerpt

School-based health centers have emerged as part of the provider network serving uninsured and publicly insured children. Today, the centers' ability to care for these children has become increasingly dependent on their success in contracting with managed care plans as providers. Because of the sizable Medicaid population seen by the centers, the transformation of Medicaid from a fee-for-service to a managed care model has required centers to forge relationships with managed care plans. Enactment of the State Child Health Insurance Program (SCHIP), and the likelihood that managed care will be the dominant model of serving children under this program, leaves little doubt that partnering with managed care will be essential if school-based health centers are to receive reimbursement for serving the large portion of their clientele who are, or will be, publicly insured.

To explore the future of school-based health centers in a world increasingly dominated by managed care, the Making the Grade National Program Office joined with the National Assembly on School-Based Health Care in June 1998 in sponsoring a workshop on SCHIP and school-based health centers. The workshop provided a federal overview presented by Doffs Barnette, senior advisor to the administrator of the federal Health Resources and Services Administration (HRSA), the US Dept. of Health and Human Services (HHS) office concerned with health services delivery. Abigail English, an attorney with the National Center for Youth Law, mapped SCHIP implementation across the states and pointed out opportunities that school-based health centers might seek as these programs are developed at the state level. State officials as well as representatives from school-based health centers and managed care plans from the two featured states described their experiences in the negotiation process. Additional comments from a plan perspective were offered by officials from two Los Angeles-based health plans as well as Karen Hacker, MD, president, National Assembly on School-Based Health Care (NASBHC).

BACKGROUND

School-based health centers were established in the early 1970s with the goals of making health care more accessible to adolescents and reducing the incidence of their behavior-related health problems, including teen pregnancy. Over the past 25 years the centers have expanded, increasing from a handful in the early 1980s to more than 1,100 in 1998. While the largest number of health centers are in high schools (38%), about 33% are housed in elementary schools, and 16% are in middle schools.[1]

Until recently, most school-based health centers remained outside mainstream financing mechanisms, including Medicaid. Centers depended on local, state, and federal grants, as well as private funding from foundations and hospitals. The uncertainty of these funding sources, combined with the national trend toward market-driven health care financing, has led school-based health centers to seek reimbursements from third party payers, including Medicaid and commercial insurers.

Third party payments, particularly Medicaid funding, have represented a small but growing portion of school-based health center revenues. In 1998, 15 states estimated more than $8 million in Medicaid payments to centers.[1] Over the past three years numerous centers have reported that Medicaid revenues, on average, represented under 10% of operating costs.[2,3] Only a few have reported recouping as much as one-third of their budgets from Medicaid. In 1997, North Shore (NY) University Hospital reported Medicaid fee-for-service revenues covering 29% of its school-based health center budget; Montefiore (NY) Ambulatory Care Center reported Medicaid fee-for-service revenues totaling 67% of budget.[4] At the June 1998 Making the Grade/NASBHC workshop on SBHCs and SCHIP, Colorado state official Bruce Guernsey commented that a few SBHCs are getting 25% of their operating budgets through Medicaid managed care arrangements. …

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