There is no single funding stream for school-based health centers (SBHCs) and wellness centers in California, and no dedicated state funding. Instead, they are funded through a variety of sources that depend on their lead agencies, student populations, communities and local resources.
These funding sources include: reimbursement from Medi-Cal and other third party payers; local, state, and federal grants; private foundation or corporate grants; subsidies from their lead organizations; donations; and/or in-kind contributions from schools districts and other partners.
State Funding Opportunities
The California School-Based Health Alliance (CSHA) has created a guide to assist in local planning and strategy that shows schools and partners how they can braid together state funding opportunities to support new school-based health and wellness centers or expand and improve existing ones.
These funds include billions of dollars in statewide grants for the following:
- Full-Service Community Schools – any school serving pre-Kindergarten through high school students using a “whole-child” approach, with “an integrated focus on academics, health and social services, youth and community development, and community engagement.
- Children and Youth Behavioral Health Initiative (CYBHI) – a $4.7 billion investment to enhance, expand and redesign the systems that support behavioral health for children and youth 0 -25. CYBHI includes many workstreams, including:
- Statewide Multi-Payer Fee Schedule for School-Linked Behavioral Health Services – new funding mechanism requiring Medi-Cal and commercial health plans to reimburse school-linked providers, regardless of network provider status, for services provided to students.
- School-Linked Partnership and Capacity Building Grants to help support institutional readiness for the statewide multi-payer school-linked fee schedule by providing resources to schools to expand its provider capacity, develop critical partnerships, and build the necessary infrastructure.
- Certified Certified Wellness Coaches – new provider type who will provide non-clinical support to youth on or near school-campuses. By 2025, some services provided by Wellness Coaches will be reimbursable through Medi-Cal.
- Evidenced-Based and Community-Defined Practices Grants (CYBHI) – to improve access to critical behavioral health interventions by scaling evidenced-based and community defined practices based on robust evidence for effectiveness, racial equity impact, and sustainability
- Mental Health Student Services Act – Provides grants to promote partnerships between county mental health agencies and local education agencies to deliver school-based mental health services to young people and their families.
For a more detailed overview of a wide range of funding opportunities, please see Braiding New Funding to Support California SBHCs.
Third-Party Reimbursement
School-based health and wellness centers run by community clinics, hospitals, and other licensed health care providers can bill public and private health insurance programs for many of the services provided.
These include Medi-Cal, Medi-Cal managed care, Family PACT, Minor Consent Medi-Cal, County Specialty Mental Health Services, and the Child Health and Disability Prevention (CHDP) program. Beginning in 2024-25, this will also include Behavioral Health-specific billing through the CYBHI Multi-Payer Fee Schedule.
About half of children in California are covered by Medi-Cal, and most of these children are enrolled in managed care plans run by local initiatives (e.g., Partnership Health Plan of California) or commercial carriers (e.g., Anthem Blue Cross). In order to bill Medi-Cal managed care plans, the largest payer for health care for children and California, the provider needs to have a contract with that plan and individual clinicians may need to be “credentialed” with it.
A few other things to know:
- School-based health and wellness centers run by community health centers or FQHCs have access to enhanced, cost-based Medi-Cal reimbursement rates when compared to other provider types. This makes them a good option for operating SBHCs.
- Most billing is now done electronically, with a few exceptions, and Electronic Practice Management (EPM) systems are commonly linked to Electronic Health Records (EHRs) to support a streamlined process.
- An effective revenue cycle includes not only submitting the initial claim for services rendered but also a mechanism to track and reconcile payments, correct and re-submit claims, and manage any payer denials in a timely manner.
- Centers run by school districts may currently only bill under the CHDP, LEA Medi-Cal, and School-based MAA programs, but will soon be able to expand billing opportunities under the CYBHI Multi-Payer Fee Schedule for behavioral health services. Additionally, as of 2020, changes to the LEA Medi-Cal Billing Option Program make it a more attractive option for many school districts. These changes include adding practitioners and services to the program and expanding services to all Medi-Cal enrolled students, not just those in special education. For more information on each of these school district funding options, see our Education Funding web page.
Although billing and capturing third-party reimbursement is complex, it is one of the most important factors in developing a sustainable school-based health and wellness center. Fortunately, most community health providers have billing systems in place and can use these systems to support their centers in securing reimbursement.
Our guide on maximizing third-party billing covers best practices for the Child Health and Disability Prevention Program (CHDP), FamilyPACT Program, Medi-Cal Managed Care, and Minor Consent Medi-Cal.
Grant Funding & Other Support
Very few school-based health and wellness centers can be sustained by third-party reimbursement alone.
Strong school-based health programs typically provide some services that can’t be reimbursed, including outreach, case management, classroom education, health fairs, peer health education or other youth development programs, food distribution, and/or support for school staff wellness. In addition, some clinical services may not be reimbursable due to the student’s insurance coverage, medical necessity, or other barriers.
Therefore, grant funding usually comprises a good segment of a school-based health and wellness center budget. Ideally, centers will be able to secure some portion of grant funding that is non-restricted, and can be sustained over time to support the basics of its operations, including administration and management. Local health departments or hospital community benefits may provide such a source.
However, it is more common for school-based health and wellness centers to seek and secure a variety of short-term grants from foundations and government sources that require specific projects and deliverables. These may be organized around areas such as tobacco use prevention, asthma, trauma screening, or teen pregnancy prevention, for example.
It will benefit the SBHC to be creative and expansive in seeking grant funding, and to utilize what are often deficit-based approaches to funding into positive programs and services that build the innate strengths and assets of children, youth and communities.