Nuts and Bolts #3 Funding for School-Based Health Centers

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Objectives The participant will be able to: Identify local, state and federal opportunities and models of funding Identify local, state and federal opportunities and models of funding Identify common community partners involved in funding options Identify common community partners involved in funding options Identify foundation support for SBHCs Identify foundation support for SBHCs

4 Maslow’s Hierarchy of Need It’s hard to focus on best practice standards when your needs are rooted in basic survival. School health clinics fight for lives Karina Bland The Arizona Republic March 12, 2001

5 Multiple Funding Sources/ Models for School-Based Health Centers Federal grants Federal grants State grants State grants Local funding Local funding Community partnership contributions Community partnership contributions Foundations Foundations Patient Revenue Patient Revenue Mixing several or all funding sources Mixing several or all funding sources

6 Foundations Federal Public Grants Local Funding/ Community Partners State Public Grants SCHIP Medicaid Private insurance Patient fees Federal entitlement programs administered at the state level MCHB/Title V CDC HIV/AIDS Prevention SAMHSA/Title XIX (substance abuse and mental health screening and early intervention) Title XX/ Soc Services Block Grant (TANF, daycare, child neglect and abuse) State Funding State General Revenue Tobacco Tax/Settlement Education NCLB /ESEA (Title I improving academic achievement of the disadvantaged and Title IV safe and drug free schools) IDEA (health-related special education services) BPHC/FQHC (Section 330 of the Public Health Service Act) Title X of the Public Health Service Act: Family Planning Figure 1 School-Based Health Center Funding Models Patient revenue Foundations that commonly supports school-based health care Robert Wood Johnson Foundation KB Reynolds Charitable Trust WKKF Kellogg Foundation Welborn Foundation McKesson Foundation Duke Endowment Health Foundation of Greater Cincinnati Visit the Grantsmanship Center at and the Foundation Center at for other foundation funding opportunities Local Funding Public and private grants (e.g., universities, United Way) City/county funds Local businesses (e.g., banks, insurance companies) Community Partners In-Kind Contributions from schools, hospitals, health departments, community health departments, and community agencies (e.g., staff, facilities, supplies) Examples of Partners Parents’ employers Parents’ health insurance agencies Local businesses School districts Universities

7 Federal public grants BPHC /FQHC (Section 330 of the Public Health Services Act) BPHC /FQHC (Section 330 of the Public Health Services Act) Title X of the Public Health Services Act: Family Planning Title X of the Public Health Services Act: Family Planning

8 Core Funding Models Federal 330 Federally Qualified Health Centers 330 Federally Qualified Health Centers Entirely federally dependent Entirely federally dependent Fairly stable Fairly stable Limited community Limited community Limited funds for expansion Limited funds for expansion

9 State public grants Federal entitlement programs administered at state level Federal entitlement programs administered at state level –MCHB Title V –CDC HIV/ AIDS Prevention –SAMHSA/ Title XIX (substance abuse and mental health screening and early intervention –Title XX/ Social Services Block Grant, Temporary Aid to Needy Families Programs (TANF) job training, pregnancy prevention, daycare, child neglect and abuse

10 State public grants Education Education –NCLB/ESEA (Title I improving academic achievement of the disadvantaged and Title IV safe and drug free schools) –IDEA (health-related special education services)

11 State public grants State Funding State Funding –State General Revenue –Tobacco Tax Settlement –Juvenile Justice Funds

12 Core Funding Model State Grants Louisiana – MCHBG; Tobacco settlement Louisiana – MCHBG; Tobacco settlement Connecticut – MCHBG, state fund Connecticut – MCHBG, state fund Delaware – state fund Delaware – state fund Fairly stable Fairly stable Limited growth; targeted funding Limited growth; targeted funding Requires legislative/administrative advocacy Requires legislative/administrative advocacy

13 Local Funding Public and private grants (universities, United Way Public and private grants (universities, United Way City and county funds City and county funds Local businesses (banks, insurance companies) Local businesses (banks, insurance companies)

14 Core Funding Models Local Government Portland/Multnomah County (OR) Portland/Multnomah County (OR) Seattle/King County (WA) Seattle/King County (WA) Great community buy in Great community buy in Fairly stable income Fairly stable income

15 Community partners In-kind contributions (staff, facilities, supplies) from In-kind contributions (staff, facilities, supplies) from –Schools, –Hospitals, –Health departments, and –Community agencies

16 Community partners Examples of partners Examples of partners –Parents’ employers –Parents’ health insurance agencies, –Local businesses, –School districts, and –Universities

17 Core Funding Models Community Partnerships Denver SBHCs Denver SBHCs Baltimore County Public Schools, MD Baltimore County Public Schools, MD Healthy Kids, Lexington, KY Healthy Kids, Lexington, KY Indianapolis Collaborative Indianapolis Collaborative Collaboration has inherent difficulties Collaboration has inherent difficulties Built over long-term Built over long-term Requires perseverance, leadership Requires perseverance, leadership

18 Foundations Robert Wood Johnson Robert Wood Johnson WK Kellogg Foundation WK Kellogg Foundation KB Charitable Trust KB Charitable Trust Health Foundation of Greater Cincinnati Health Foundation of Greater Cincinnati McDonald Foundation McDonald Foundation Welborn Foundation Welborn Foundation

19 Foundations For other foundation funding opportunities visit For other foundation funding opportunities visit –The Grantsmanship Center at and –The Foundation Center at

20 Core Funding Models Foundations Indianapolis SBHCs Indianapolis SBHCs Cincinnati, Ohio SBHCs Cincinnati, Ohio SBHCs North Carolina SBHCs North Carolina SBHCs Miami SBHCs Miami SBHCs

21 Patient Revenue SCHIP SCHIP Medicaid Medicaid Private insurance Private insurance Patient fees Patient fees

SBHC and Billing Insurance From the Census From the Census

Insurance Billing by Type Census

24 Core Funding Model Patient Revenue West Virginia – FQHC rate West Virginia – FQHC rate New York – Medicaid institution rate New York – Medicaid institution rate Commitment to specific sponsor type Commitment to specific sponsor type Leadership necessary at Medicaid level Leadership necessary at Medicaid level

25 Mixed Funding Sources Denver School-Based Health Centers Denver School-Based Health Centers Baltimore County School-Based Health Centers Baltimore County School-Based Health Centers Healthy Kids Centers Healthy Kids Centers Indianapolis Collaborative Indianapolis Collaborative

Non Patient Revenue Census Census

27 Follow the Income Streams Education Mental Hlth/Sub Abuse Public Health Care

28 Funding Service Components Medical/nursing services Medical/nursing services Public health/promotion Public health/promotion Mental health/behavioral health Mental health/behavioral health Case management/social services coordination Case management/social services coordination Education support Education support

Funding Challenges: Challenges: –Confidentiality –Provider type –Insurance type –Keeping true to the model –Finding the mix that works