When California elementary, middle and high school students return to school this fall, almost 230,000 of them will have access to health care through school-based health centers. That's an increase of more than 25,000, the largest one-year jump since the California School Health Centers Association started keeping track in 2004.
School-based health clinics have more than doubled in California in the past decade -- from 108 in 2002 to 226 in operation now. Another 37 California schools are in the process of opening clinics.
Nationally, about 2,000 school-based health clinics offer care to about two million students, according to the School-Based Health Alliance, a national advocacy group.
Most clinics are associated with schools where 70% or more of the students receive no-cost or reduced-price meals.
School-based health centers are growing in number and size across the country, "but I would say we're experiencing a higher rate of growth than other states," according to Serena Clayton, executive director of the California School Health Centers Association.
"Part of the growth is due to funding in the Affordable Care Act," Clayton said. "That $200 million for facilities is certainly promoting a fair amount of growth, but even without the ACA, demand is growing and word is spreading. The more centers there are, the more visible they are and other districts start to realize what a good idea they are.
"I think demand is growing based on the success of the model," Clayton said.
ACA Support Ends in 2014
Using part of $200 million allocated for solving infrastructure problems under the health care reform law, HHS and the U.S. Department of Education over the past three years handed out $95 million in grants to build and expand school-based health centers. California schools received about $30 million.
In addition to funding, the ACA also includes language authorizing and supporting school-based health centers, but that part of the law is due to sunset at the end of 2014.
California Rep. Lois Capps (D-Santa Barbara) last month introduced a bill in Congress that would extend federal support for school-based health centers for another five years.
"These centers provide vital preventative and primary health care services to over two million students nationwide," Capps said when she introduced HR 2632. "They are often the only source of health care for children and adolescents, and they are easily accessible, keeping students healthy, in school and learning."
"My bill is simple and straightforward. It reauthorizes the only source of federal support dedicated to the operations of school-based health centers," Capps said.
Capps' School-Based Health Centers Act calls for no money from the federal government. It extends for five years language already in place that authorizes appropriations for operational grants under the school-based health centers program. It keeps the framework intact to support and, possibly someday, provide funding for school-based health centers.
The bill -- with 24 co-sponsors, including eight from California -- faces a bumpy road ahead.
Because it's associated with the ACA and because "it could someday mean money would have to be appropriated," according to Clayton, the bill could face opposition from Republicans.
"We don't really know what to expect," Clayton said. "There are certainly plenty of Republicans who have been supportive of school-based health centers in their states. Sometimes they have sided with their party, which has always been opposed. But some Republicans are quite supportive in concept," Clayton said.
Poised for Switch From Coverage to Delivery
Clayton predicts schools will become a more common venue to deliver health care when the reform emphasis switches from insurance coverage to care delivery.
"There's a pure logic to having health care access in schools that just can't be denied," Clayton said. "Once we get past the starting point of getting everybody covered, I think we'll start moving toward better models of delivery. Schools just make so much sense for everybody -- for providers, for students, for families."
Clayton said she sees parallels between the national movement over the past couple decades for schools to provide no- and low-cost meals to low-income students.
"I think that's an excellent way to look at it, and I hope that's the way people will think about it," Clayton said.
"The idea of providing meals in schools is the same concept -- kids can't learn if they're hungry. That's the same thinking that goes with health care services. Kids can't learn if they're not healthy and in their seats."
Most school-based clinics now are based in low-income areas, but Clayton hopes that will change.
"I think it eventually will be something that every school thinks about, but it will always be tailored to the community," Clayton said.