A Place for School-Based Health Centers within the New Era of Alternative Payment Models in Medicaid

Abstract

School-based health centers are a key part of the health care delivery system in many states, particularly in addressing the needs of low income and underserved communities.  As the momentum for adopting alternative payment models (APM) develops and influences the reimbursement of Medicaid services, school-based health centers (SBHC) should be included in APM models.  SBHCs serve as vital primary care sites for youth living in low income communities. Delivery systems undergoing alternative payment model reform will do well to leverage school-based health centers as a means to address health disparities experienced by low income, underserved youth.

There are a handful of states that have begun to strategically embed school-based health centers into alternative payment models.  New York State recently announced it will be moving SBHCs into the state’s Medicaid Managed Care program in July 2016, and transitioning reimbursement away from fee-for-service.  Per member per month (PMPM) payments linked to school enrollment data can offer better budget predictability for the provider groups that serve as operating sponsors of SBHCs.  In some cases, upfront, capitated payments can serve as the initial investment capital needed to build and operate new SBHC sites in order to capture the financial savings generated when managing patients in this lower cost setting.  Through Medicaid 1115 waivers, states are innovating and transforming the way care is delivered and paid for within their state.  Statewide lessons should be studied and shared nationally in hopes of creating policies that shape a comprehensive and standardized reimbursement environment which supports and expands the financial sustainability of school-based health centers.