School-Based Health Center Proponents Lobbying for Funding

California school and health care leaders have joined ranks with officials from other states urging Congress to put money behind an idea with widespread but underfunded support: health care centers based in schools.

Tom Torlakson, California’s state Superintendent of Public Instruction, and 18 superintendents from school districts across the state added their names to a letter delivered to Congress asking for $50 million in federal funding.

The letter, sent to Sen. Tom Harkin (D-Iowa) and Rep. Jack Kingston (R-Ga.) – chairs of the Senate and House Appropriations Subcommittees on Labor, Health and Human Services, Education and Related Agencies – is signed by nearly 75 education and health leaders from several states and the National Assembly on School-Based Health Care.

Officials at the California School Health Centers Association estimate California’s share, if the money were approved for the 2014 budget, would be about $8 million.

Nationally, almost 2,000 school-based health centers provide primary care, mental health care, counseling, family outreach and chronic illness management. The centers “serve as a vital access point for primary and mental health care for students who otherwise would go without,” according to the letter from the National Assembly on School-Based Health Care.

In Step With Long-Term Reform Goals

Serena Clayton, executive director of the California School Health Centers Association, said government support for school-based health centers makes sense because delivery methods and goals match up closely with those in the Affordable Care Act.

“We really think this is in line with long-term goals for the larger concept of health care reform,” Clayton said.

“The push right now is toward getting everybody insured, but the bigger picture of making low-cost preventive services available, encouraging healthy habits and getting people to take active part in their own health — school-based health centers are exactly that. Part of the bigger goal of reform is to take health care services to where people are — to places where people can address the risks of obesity and encourage physical activity. Schools are the perfect places for that,” Clayton said.

Although school-based health centers are encouraged in the Affordable Care Act, and there appears to be widespread, bipartisan support for the concept, national proponents are leery of leaning too heavily on the reform connection.

“We’re trying to be very careful about messaging this as not a function of the Affordable Care Act, but as an ongoing campaign to strengthen community safety nets,” said John Schlitt, vice president for policy and government affairs at the National Assembly of School-Based Health Care.

“It’s very hard to assess the mood in Washington,” Schlitt said. “It’s very challenging to be asking for new dollars in this fiscal environment, but I’ve been involved in trying to get funding for health care one way or another since 1989 and I can tell you there’s never a good time to ask Congress for money. You have to do it though,” Schlitt said.

Schlitt said anecdotal reports from several parts of the country suggest elected officials — Republicans and Democrats — who visit school-based health centers almost always come away impressed and talking like supporters.

“However, transferring that verbal support into votes is a different, difficult matter,” Schlitt said.

Senate budget discussions are underway. Schlitt said proponents expect to hear soon if the funding will be included in a budget proposal.

What California Could Get With $8 Million

About 200 school-based health care centers are up and running in California at various levels, ranging from a part-time nurse on campus to a full-blown health center offering primary care for students and their families. Legislation passed in 2006 and 2008 and signed by Gov. Arnold Schwarzenegger (R) created the framework for health clinics in public schools. But so far, there is no state money designated for school-based clinics. California School Health Centers Association officials hope to change that, but for right now, attention is turned to toward securing federal funding.

With its share of $8 million in federal funding, California School Health Centers Association officials said the state could do one of the following (or some combination of multiple efforts):

• Provide medical care to 32 uninsured patients each week at 160 school-based centers for a total of almost 250,000 additional visits per year;

• Hire mental health clinicians at 100 school-based centers to provide therapy, including crisis, grief, and long-term counseling, to uninsured students, reaching 15,000 students each year;

• Provide 120 school-based outreach and enrollment specialists to help more than 100,000 students and family members sign up for insurance; or

• Hire youth program facilitators at 120 school-based centers to lead school-wide efforts to build a healthy school climate, prevent and address violence, and promote positive youth development.

Sacramento Lobbying Also on Agenda

Stakeholders say California has a strong national presence in school-based health center efforts with clinics in many districts and a robust well-staffed office at the California School Health Centers Association based in Oakland.

But what California lacks — and some other states have — is a steady funding source.

“California has no state funding for school health centers, whereas a lot of other states — New York, Oregon and others — do have a steady state funding stream,” Clayton said. “We hope to establish that funding mechanism here,” Clayton added.

Clayton hopes proponents can take advantage of California’s new, brighter fiscal outlook and get funding for the two bills passed several years ago — AB 2560 and SB 564 — as well as for a new bill in the Legislature now — AB 174 by Assembly member Rob Bonta (D-Oakland). Bonta’s bill would create a program for school-based mental health services for California students affected by traumatic events or violence in their communities.

“We have this package of three bills now that we believe create a solid program,” Clayton said.

She said $10 million in funding “is a reasonable starting place for a state that isn’t exactly flush. With $10 million, there are some significant things that could be done.”

Assembly member Holly Mitchell (D-Los Angeles), chair of the Assembly Budget Subcommittee on Health and Human Services, believes school-based health centers make sense in California and deserve funding.

“I think that as we talk about the Affordable Care Act rollout and look back at what we’ve learned about the delivery of health care, school-based health centers meet all the criteria — they’re community based, trusted and they provide a good point of access for the health system.”

Mitchell said California’s new fiscal situation after voters approved a sales tax increase last fall presents an opportunity for the Legislature to reconsider spending options.

“I think now we’re in a place where we can talk about establishing a list of priorities and begin figuring out how much each item on the list might cost,” Mitchell said.

Mitchell said “the figure of $10 million is a reasonable place to start the conversation” about school-based health centers.

Clayton said California advocates will continue lobbying for federal and state money.

“Our sense is if we get anything at either level it will be amazing,” Clayton said.

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