Options for sustaining school-based health centers.

Several methods exist for financing and sustaining operations of school-based health centers (SBHCs). Promising sources of funds include private grants, federal grants, and state funding. Recently, federal regulation changes mandated that federal funding specifically for SBHCs go only to SBHCs affiliated with a Federally Qualified Health Center (FQHC). Becoming a FQHC allows a SBHC to bill Medicaid at a higher rate, be notified about federal grants, and access the federal drug-pricing program. However, FQHCs must bill for services, including a sliding-fee scale based on ability to pay; develop a governance board with a majority of consumer members; provide a set of designated primary care services; and serve all people regardless of ability to pay. Private grants impose fewer restrictions and usually provide start-up and demonstration funds for specific program needs. Such funds are generally time limited, so new programs need to be incorporated into the operational budget of the center. State funding proves relatively stable, but fiscal challenges in some states made these funds less available. Using a variety of funding sources will enable ongoing provision of health care to students. Overall, SBHCs should consider infrastructure development that allows a variety of funding options, including formalizing existing partnership commitments, engaging in a needs assessment and strategic planning process, developing the infrastructure for FQHC status, and implementing a billing system for client services.