Insight & Analysis / School Clinics See More Medicaid Clients, Fewer Uninsured Kids
School-based health centers (SBHCs) are seeing more children, including an increasing proportion who are covered by public insurance.
The clinics, located on school grounds, provide primary care as well as dental health care, immunizations and other services to students with limited access to care, often because they are low income or live in isolated areas.
Visits to SBHCs grew by 62 percent between the 2006-07 and 2013-14 school years, climbing from 20,964 to 33,879 visits, largely due to the increase in the number of centers.
Uninsured children and those covered by Medicaid or Child Health Plan Plus (CHP+) represent the majority of SBHC users. While about two-thirds of Colorado children are covered by commercial insurance, less than 11 percent of SBHC users have commercial policies.
The insurance status of children who use SBHCs has shifted over the last seven years. Children with Medicaid made up more than half of SBHC users in the 2013-14 school year compared with less than a third in the 2006-07 school year. That increase coincides with a decrease in the proportion who are uninsured. In the 2006-07 school year, 45 percent of users were uninsured compared with 20 percent in the 2013-14 school year. Children covered by CHP+ made up 6.2 percent of SBHC users in both 2006-07 and 2013-14.
The shift most likely is because Colorado children who were previously uninsured gained coverage.
A “welcome mat effect” resulting from increased media attention about Medicaid expansion led to more families understanding that their children were eligible for Medicaid coverage. SBHCs engaged in aggressive enrollment outreach efforts as well.
The changing payment mix for SBHCs, especially with fewer uninsured children and more covered by public insurance, could be a more sustainable funding model for SBHCs.