Expanding Health Care Coverage

Grantee Name

Children’s Defense Fund - New York

Funding Area

Expanding Health Care Coverage

Publication Date

April 2016

Grant Amount


Grant Date:

July 2012 – January 2014

A series of challenges, including State regulations and reimbursement rules, had impeded the expansion of school-based health centers (SBHCs) across New York State.

SBHCs provide an affordable source of primary care to underserved children but face difficulties in contracting with health plans, including those that serve children covered by Medicaid or Child Health Plus. As a result, care can be fragmented and providers may be left without compensation. The Affordable Care Act created new opportunities to improve delivery and support expansion of SBHC services, with $200 million in funding allocated to establish or expand SBHCs nationwide. NYHealth awarded the Children’s Defense Fund a grant to work with key partners on developing recommendations for expanding and sustaining SBHCs in New York.

Outcomes and Lessons Learned

  • Engaged policymakers, SBHC providers, and SBHC administrators at monthly meetings to discuss integrating SBHCs into Medicaid managed care reimbursements;
  • Developed recommendations to ensure adequate reimbursement and phase in the transition to Medicaid managed care;
  • Produced the report, “School-based Health Centers in New York State: Ensuring Sustainability & Establishing Opportunities for Growth;” and
  • Established a monthly workgroup meeting with New York State officials to discuss how to effectively integrate SBHC providers into a Medicaid managed care reimbursement system.

The work gained traction in Albany. In reaction to the report, Senator Gustavo Rivera and Assemblyman Richard Gottfried co-hosted a roundtable in Albany in 2014 to examine SBHCs and compare cost-of-care models to support them. Since the report’s release, ongoing workgroup meetings among the New York State Department of Health, managed care organizations, and providers have effectively addressed nuances in credentialing and reimbursement that will guarantee SBHC sustainability and expansion statewide. Transition for SBHCs into managed care is scheduled for completion by July 2017. Until complete transition, stakeholders of the workgroup are committed to meet monthly and negotiate provisions to ensure that SBHCs and services for children and youth can thrive in a managed care environment.

Co-Funding and Additional Funds Leveraged: N/A