Based upon a 2008 analysis, "Planning and Sustaining a School-Based Health Center: Cost and Revenue Findings from Oregon
", the cost to operate an SBHC in Oregon is estimated at $150,000-250,000/year. Oregon's School-Based Health Center (SBHC) program has benefited from 25 years of support by the Oregon Health Authority (formerly the Department of Human Services) and the Oregon Legislature. What began with an initial commitment of $212,000 to partially fund five SBHCs grew to a commitment of $5,839,000 to support 63 certified SBHCs.
While SBHCs are encouraged to bill third party insurers, including Medicaid, for their services, many of the required services are not covered by health care insurance and many of the patients served by SBHCs do not have insurance. SBHCs are required to provide service to all students without regard to the student's ability to pay.
Given the gap between available funds from insurance payments and the required services and population to be served, the Oregon Legislature has provided funding to supplement and sustain SBHC services. State funding is intended to supplement other funding sources, both public and private, at the local level.
Prior to July 1 2005, SBHCs were historically funded through a competitive grant process wherein the successful SBHCs in the state received grants of $52,619 per SBHC, while the remaining 24 that grew over the years received no direct state funds. All centers maintained similar levels of care, but without State assistance. This created considerable inequity statewide. However, when there was a legislative interruption of funds in February 2003 due to the failure of Measure 28, state-funded SBHCs were more severely impacted than those clinics that were less reliant on state dollars. As state dollars were fully reinstated in Fall 2003, the opportunity arose to re-evaluate the funding formula. After discussions with the Oregon School-Based Health Care Network, the not-for-profit advocacy group for SBHCs, and the Conference of Local Health Officials, a new funding formula emerged that aligned SBHCs with the public health delivery system for stability and ongoing support.
Each county that has a state-certified SBHC is eligible for state dollars through their local public health authority (LPHA). The LPHA is provided funds to support SBHCs and SBHC systems based on the number of state certified SBHCs in the county and the availability of legislatively approved dollars. As long as an SBHC maintains its certification status with the State Program Office, it is eligible to receive state funds. The specific expenditure of the funds is a local level decision between the LPHA and local partners. Since the State Program Office funds are limited, funds for new SBHCs are awarded from time-to-time through a Planning Grant process.
During the 2007-2009 biennium, the largest expansion in Oregon's SBHC history occurred with 18 planning sites in counties with and without existing centers. Working within the 2005 range funding formula, many counties began to reevaluate the sustainability of their current centers when presented with the opportunity to open new centers. This initiated the discussion of the current effectiveness of the 2005 range formula within the context of sustainability and expansion. In response, in January 2009, the funding workgroup convened to (1) revisit how State General Fund dollars support the overall mission of SBHCs in Oregon; (2) examine the effectiveness of the current funding formula in the present times; and (3) explore other funding formula models to improve sustainability and expansion efforts with the possibility of recommending a revised formula.
Based on the workgroup discussions a new funding formula was implemented July 1, 2009 stating:
Counties with only one certified SBHC receive $60,000/yr
Counties with > 1 certified SBHC receive $41,000/yr for each center.
For more details on:
In order to receive state funds to supplement the operation of an SBHC, the SBHC must meet State Certification Standards. Oregon’s SBHC Standards require SBHCs to:
Operate either within a school setting or on school property;
Be open three days each week during the school year;
Provide either directly or through referral sources, comprehensive physical health, mental health and dental services;
Provide at least ten (10) hours/week comprehensive primary care services from an on-site Primary Care Provider who has an independent scope of practice (MD, DO, ND or NP)
Provide at least ten (10) additional hours of medical or mental health services
The attached document, SBHC Roles, describes the roles that must be filled. In addition to the State’s required service level, SBHCs are required to monitor and report on three Key Performance Measures (KPMs) for students seen three or more time in a school year:
- A Comprehensive Physical Exam must be conducted or obtained from the student’s primary care physician;
- A Health or Risk Assessment must be completed on key areas of pediatric growth and development;
- The student’s Body Mass Index (BMI) must be tracked.
Finally, each SBHC must conduct Patient Satisfaction Surveys and provide their data to the State Program Office.
As the number of SBHCs in Oregon continues to grow, the state program office works with federal, state and local partners to help identify ways to maximize efficiency and strategically plan for improved sustainability. Some efforts may include improving the SBHCs ability to bill third parties, assisting SBHCs to participate in Oregon’s patient-centered medical home or health home models of care, establishing a standardized SBHC Electronic Health Record, advocating for reimbursement of early intervention and more prevention services as provided in SBHCs, and identify best practices for public/private partnerships supporting SBHCs.
For more information about planning a new School-Based Health Center, please visit SBHC Planning