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Federal Health Care Reform: Here's what passed

Follow this link to see the final language on SBHCs in the health care reform bill.

1. Emergency Funding for SBHCs (Sec. 4101(a))

This provision provides $200 million over four years ($50 million/year) for SBHCs. Unfortunately, the original intent of the provision to provide funding for operations was amended by Senate appropriators in closed-door negotiations and is now restricted to expenditures for facilities (construction, expansion, improvements, equipment) and can not be used for operations. Appropriators made these changes because of a misconception that operations are supported through 330 funds.

NASBHC continues to work with staff and members to expand the use of these funds to include operations, however they estimate the likelihood of success as slim.

Guidance for the funds is due in June. It is clear that these funds will be allocated through a competitive grant cycle and FQHCs will be eligible.

2. SBHC Authorization (Sec. 4101(b))

This section of the bill creates a new federally authorized program. An authorization means that SBHCs are an “officially recognized” federal program, but it does not guarantee that the program will be funded.

NASBHC is working on FQHC eligibility to apply for funding through the authorization (when it gets funded). Congress wants to avoid duplication or overlap of federal funding; therefore sponsoring agencies that receive 330 funds to run a SBHC program will not be eligible for additional funding for the same SBHC program. These are issues that will be addressed in regulations which will not be written until an appropriation is allocated to the authorization program.

In March, President Obama released A Blueprint for Reform: Reauthorization of the Elementary and Secondary Education Act (ESEA). Congress originally passed ESEA, currently known as the No Child Left Behind Act, in 1965. Today, it continues to govern federal involvement in education, providing billions of dollars in formula and competitive grants to states, school districts, and schools. Over the coming months, a bipartisan group of congressional leaders will work with Secretary of Education Arne Duncan to propose revisions to ESEA. Obama’s Blueprint will serve as a key input.

Read the full Blueprint.

Role of Student Support in the Blueprint

We are encouraged to see that the Blueprint recognizes the critical role of support services in improving academic outcomes and overall wellbeing. It calls for an increased federal commitment to student support services, and promotes comprehensive approaches designed to foster positive school climate, improve parent engagement, and address student health and safety needs. First, the Blueprint maintains the current funding level for 21st Century Community Learning Centers. Second, the Blueprint proposes a significant additional investment in Promise Neighborhoods, comprehensive cradle-to-college partnerships modeled after the highly successful Harlem Children’s Zone. Third, and finally, the Blueprint consolidates a variety of existing efforts into a single, better-funded Successful, Safe, and Healthy Students program, designed to improve physical and mental health, safety, and family engagement.

In his testimony before the House Appropriations Committee, Secretary Duncan emphasized that “student supports are needed to insure the proper learning environment,” and noted that the Administration seeks $1.8 billion “to improve school climate, student health, student safety, parental engagement, and community involvement.”

Read Secretary Duncan’s full testimony.

Other Key Changes Proposed in the Blueprint

Beyond student support services, A Blueprint for Reform recommends significant additional changes to current ESEA law. These include, but are not limited to:

• A somewhat broader instructional approach, designed to roll back No Child Left Behind’s curriculum narrowing but maintaining emphasis on reading, writing and math


• A new focus on student growth, rather than absolute performance level, in measuring academic achievement and school progress toward goals


• Revisions to accountability systems to incorporate incentives and rewards, as well as to allow fairer and more appropriately targeted interventions in a smaller number of very low-performing schools, districts, and states


• New requirements for “teacher effectiveness” classifications, based in significant part on student achievement results


• An emphasis on resource equity, including required reporting, to address funding and staffing disparities between low- and higher-income schools

Unfortunately, it is not yet clear whether there is the political will to support ESEA reauthorization before Congressional elections in November. Recently, analysts have become less optimistic that legislators will want to tackle the issue during an election year. However, the Senate HELP committee, chaired by Sen. Tom Harkin (D-IA) has been holding a series of reauthorization hearings. On May 18th, the committee addressed the issue of health and schools. Dr. Barbara Levin, CEO of Chota Community Health Services, testified, explaining the link between SBHCs and academic success.

Read Dr. Levin’s full testimony.

The Governor’s budget proposed in May 2010 contains cuts to Medi-Cal, Healthy Families, mental health, and CalWORKS that could be detrimental to school health center sustainability and to the health of the children and families we serve. For an overview, we suggest the excellent summaries provided by the following organizations:

The legislature has rejected a number of the Governor’s proposed cuts (see below), but as we know from recent difficult budget years, it’s not over until it’s over (and even then it’s still not over). So stay tuned. CSHC is joining with other organizations to support a budget that protects children and includes a balanced mix of new revenues and cuts. We urge our members and supporters to support these efforts:

• Please join the Children's Movement in sending a loud and clear message to the leadership of California: "Don't cut kids!" This is a quick and simple way that you can be part of the advocacy voice for children.


• Please join Community Health Councils, Inc. in their statewide budget postcard campaign to ask the Governor and state legislators to stop harmful cuts to California's safety net and healthcare system, place revenue options back on the table, and reinvest in California 's economy and families.

Below are highlights of significant actions taken by the Assembly and Senate in response to the May Revision as of June 5th. Thank you to the Latino Coalition for a Healthy California for this summary.

• Rejected the Governor's proposal to increase monthly premiums and copayments for the Healthy Families Program (HFP).


• Rejected the Governor's budget proposals to increase Medi-Cal cost sharing including: $5 copayments on physician/clinic/dental visits; copayments on prescriptions; copayments on emergency room visits; and $100 per day copayment for inpatient hospitalization up to a maximum of $200 per admission.


• Rejected reducing full-scope Medi-Cal benefits for newly qualified legal immigrant adults living in the U.S. for less than five years, and for individuals designated as "PRUCOL."


• Rejected the Governor's May Revision budget proposal to reduce by half the In-Home Supportive Services (IHSS) program. Instead the Administration is directed to convene a stakeholder process to develop proposals to achieve savings in the program.


• Rejected the Governor's proposal to eliminate the CalWORKS program and the Recent Noncitizen Entrants Program (RNE). This proposal would have affected 580,000 families and more than one million children. The RNE program provides temporary cash assistance to approximately 22,500 lawful immigrants who have not yet been in the country for five years.


• Rejected the Governor's proposal to reduce SSI/SSP grants for individuals who are aged, blind or disabled.


• Rejected the Governor's proposal to eliminate the California Food Assistance Program (CFAP) and the Cash Assistance Program for Immigrants (CAPI). CFAP and CAPI are funded by the state General Fund to provide benefits to legal immigrants who do not qualify for federal food stamps and SSI/SSP funding respectively.


• Rejected the Governor's proposal to reduce County Mental Health services by $602 million.