Nuts and Bolts #3Nuts and Bolts #3

Funding for School-Based Funding for School-Based Health CentersHealth Centers

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ObjectivesObjectives

The participant will be able to:The participant will be able to:

Identify local, state and federal Identify local, state and federal opportunities and models of fundingopportunities and models of funding

Identify common community partners Identify common community partners involved in funding optionsinvolved in funding options

Identify foundation support for SBHCsIdentify foundation support for SBHCs

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Maslow’s Hierarchy of NeedMaslow’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 BlandThe Arizona RepublicMarch 12, 2001

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Multiple Funding Sources/ Multiple Funding Sources/ Models for School-Based Health Models for School-Based Health CentersCenters

Federal grantsFederal grants State grantsState grants Local fundingLocal funding Community Community

partnership partnership contributionscontributions

FoundationsFoundations Patient Patient

RevenueRevenue Mixing several Mixing several

or all funding or all funding sourcessources

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Foundations

Federal Public Grants

Local Funding/Community Partners

State Public Grants

SCHIPMedicaidPrivate insurancePatient fees

Federal entitlement programs administered at the state level MCHB/Title VCDC HIV/AIDS PreventionSAMHSA/Title XIX (substance abuse and mental health screening and early intervention)Title XX/ Soc Services Block Grant (TANF, daycare, child neglect and

abuse) State FundingState General RevenueTobacco Tax/SettlementEducationNCLB /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 careRobert Wood Johnson FoundationKB Reynolds Charitable TrustWKKF Kellogg FoundationWelborn FoundationMcKesson FoundationDuke EndowmentHealth Foundation of Greater CincinnatiVisit the Grantsmanship Center at http://www.tgci.com/ and the Foundation Center at http://fdncenter.org for other foundation funding opportunities

Local FundingPublic and private grants (e.g., universities, United Way)City/county fundsLocal businesses (e.g., banks, insurance companies)

Community PartnersIn-Kind Contributions from schools, hospitals, health departments, community health departments, and community agencies (e.g., staff, facilities, supplies)Examples of PartnersParents’ employersParents’ health insurance agenciesLocal businessesSchool districtsUniversities

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Federal public grantsFederal public grants

BPHC /FQHC (Section 330 of the Public BPHC /FQHC (Section 330 of the Public Health Services Act)Health Services Act)

Title X of the Public Health Services Act: Title X of the Public Health Services Act: Family PlanningFamily Planning

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Core Funding ModelsCore Funding ModelsFederalFederal

330 Federally Qualified Health Centers330 Federally Qualified Health Centers

Entirely federally dependentEntirely federally dependentFairly stableFairly stableLimited community Limited community Limited funds for expansionLimited funds for expansion

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State public grantsState public grants

Federal entitlement programs administered at Federal entitlement programs administered at state levelstate level

– MCHB Title VMCHB Title V

– CDC HIV/ AIDS PreventionCDC HIV/ AIDS Prevention

– SAMHSA/ Title XIX (substance abuse and mental SAMHSA/ Title XIX (substance abuse and mental health screening and early interventionhealth screening and early intervention

– Title XX/ Social Services Block Grant, Temporary Title XX/ Social Services Block Grant, Temporary Aid to Needy Families Programs (TANF) job Aid to Needy Families Programs (TANF) job training, pregnancy prevention, daycare, child training, pregnancy prevention, daycare, child neglect and abuseneglect and abuse

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State public grantsState public grants

EducationEducation

– NCLB/ESEA (Title I improving NCLB/ESEA (Title I improving academic achievement of the academic achievement of the disadvantaged and Title IV safe disadvantaged and Title IV safe and drug free schools)and drug free schools)

– IDEA (health-related special IDEA (health-related special education services)education services)

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State public grantsState public grants

State FundingState Funding

– State General RevenueState General Revenue

– Tobacco Tax SettlementTobacco Tax Settlement

– Juvenile Justice FundsJuvenile Justice Funds

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Core Funding ModelCore Funding ModelState GrantsState Grants

Louisiana – MCHBG; Tobacco Louisiana – MCHBG; Tobacco settlementsettlement

Connecticut – MCHBG, state fundConnecticut – MCHBG, state fund

Delaware – state fundDelaware – state fund

Fairly stableFairly stableLimited growth; targeted fundingLimited growth; targeted fundingRequires legislative/administrative advocacyRequires legislative/administrative advocacy

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Local FundingLocal Funding

Public and private grantsPublic and private grants (universities, United Way(universities, United Way

City and county fundsCity and county funds

Local businesses Local businesses (banks, insurance (banks, insurance companies)companies)

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Core Funding ModelsCore Funding ModelsLocal GovernmentLocal Government

Portland/Multnomah County (OR)Portland/Multnomah County (OR)

Seattle/King County (WA)Seattle/King County (WA)

Great community buy inGreat community buy in

Fairly stable incomeFairly stable income

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Community partnersCommunity partners

In-kind contributionsIn-kind contributions (staff, facilities, (staff, facilities, supplies) from supplies) from

– Schools,Schools,

– Hospitals,Hospitals,

– Health departments, andHealth departments, and

– Community agenciesCommunity agencies

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Community partnersCommunity partners

Examples of partnersExamples of partners

– Parents’ employersParents’ employers

– Parents’ health insurance agencies,Parents’ health insurance agencies,

– Local businesses,Local businesses,

– School districts, andSchool districts, and

– Universities Universities

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Core Funding ModelsCore Funding ModelsCommunity PartnershipsCommunity Partnerships

Denver SBHCsDenver SBHCs

Baltimore County Public Schools, MDBaltimore County Public Schools, MD

Healthy Kids, Lexington, KYHealthy Kids, Lexington, KY

Indianapolis CollaborativeIndianapolis Collaborative

Collaboration has inherent difficultiesCollaboration has inherent difficulties

Built over long-termBuilt over long-term

Requires perseverance, leadershipRequires perseverance, leadership

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FoundationsFoundations

Robert Wood JohnsonRobert Wood Johnson

WK Kellogg FoundationWK Kellogg Foundation

KB Charitable TrustKB Charitable Trust

Health Foundation of Greater Health Foundation of Greater CincinnatiCincinnati

McDonald FoundationMcDonald Foundation

Welborn FoundationWelborn Foundation

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FoundationsFoundations

For other foundation funding For other foundation funding opportunities visitopportunities visit– The Grantsmanship Center at The Grantsmanship Center at

http://www.tgci.com

andand

– The Foundation Center atThe Foundation Center at

http://fdncenter.org

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Core Funding ModelsCore Funding ModelsFoundationsFoundations

Indianapolis SBHCsIndianapolis SBHCs

Cincinnati, Ohio SBHCsCincinnati, Ohio SBHCs

North Carolina SBHCsNorth Carolina SBHCs

Miami SBHCsMiami SBHCs

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Patient RevenuePatient Revenue

SCHIPSCHIPMedicaidMedicaidPrivate insurancePrivate insurancePatient feesPatient fees

SBHC and Billing InsuranceSBHC and Billing Insurance

From the 2004-05 From the 2004-05 CensusCensus

Insurance Billing by TypeInsurance Billing by TypeCensus 2004-05Census 2004-05

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Core Funding ModelCore Funding ModelPatient RevenuePatient Revenue

West Virginia – FQHC rateWest Virginia – FQHC rate

New York – Medicaid institution rateNew York – Medicaid institution rate

Commitment to specific sponsor typeCommitment to specific sponsor type

Leadership necessary at Medicaid levelLeadership necessary at Medicaid level

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Mixed Funding SourcesMixed Funding Sources

Denver School-Based Health Centers Denver School-Based Health Centers

Baltimore County School-Based Health Baltimore County School-Based Health CentersCenters

Healthy Kids CentersHealthy Kids Centers

Indianapolis CollaborativeIndianapolis Collaborative

Non Patient RevenueNon Patient Revenue Census 2004-05Census 2004-05

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Follow the Income StreamsFollow the Income Streams

Education

Mental Hlth/Sub

Abuse

PublicHealth

HealthCare

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Funding Service Funding Service ComponentsComponents

Medical/nursing servicesMedical/nursing services

Public health/promotionPublic health/promotion

Mental health/behavioral healthMental health/behavioral health

Case management/social services Case management/social services coordinationcoordination

Education supportEducation support

FundingFunding

Challenges:Challenges:– ConfidentialityConfidentiality– Provider typeProvider type– Insurance typeInsurance type– Keeping true to the modelKeeping true to the model– Finding the mix that worksFinding the mix that works