January 29, 2016

The Honorable Sylvia Burwell

Secretary, U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
The Honorable John King
Acting Secretary of Education
U.S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202
Dear Secretary Burwell and Acting Secretary King,
On behalf of the 2,300 school-based health centers (SBHCs) across the nation, we applaud
your cross-agency, coordinated recognition of the inextricable link between health and
education. In particular, we appreciate the practical steps to support healthy students
provided by the joint toolkit, Healthy Students, Promising Futures.
As your joint toolkit and letter acknowledge, SBHCs are a critical part of an effort to support
healthy students. The toolkit provides practical strategies to support healthy students
through five high-impact opportunities. SBHCs are uniquely positioned to take advantage of
these opportunities, and are currently engaged in several of these strategies. For nearly three
decades, SBHCs have operated at the intersection of primary care, public health, and
education. They are one of the best resources we have at our disposal to ensure that children
and adolescents are healthy and ready to learn.
SBHCs have a long history of connecting children and their families to health insurance
through outreach and enrollment activities. Through key partnerships with Kaiser
Permanente, for example, SBHCs are leading the effort to promote a school-wide culture of
health that extends beyond the clinic walls into the hallways, classrooms, and cafeterias.
SBHCs in Detroit, Michigan, have leveraged community benefit financing from a major
hospital system to sustain their operations, and through a partnership with Atlantic
Philanthropies, SBHC leaders in California have partnered with local education agencies and
school nurses to expand reimbursable health services in schools through recent clarification
of the free care rule. We welcome your leadership and promotion of these high impact
opportunities and hope to partner with you to expand the reach of these strategies.

As funding is increasingly constrained, every effort must be made to maximize resources and
eliminate barriers to care. While a majority of SBHCs receive some reimbursement from public
and private payers, many continue to face barriers in billing and documenting care. Under
many states Medicaid managed care programs, SBHCs that deliver essential preventive and
primary care are locked out of reimbursement because they lack recognition as essential
community providers. Furthermore, in many states SBHCs are not defined by Medicaid as a
specific provider type, and therefore Medicaid is unable to differentiate services provided at
an SBHC from those of its sponsoring agency. This policy is particularly important for directly
attributing quality performance and improved health outcomes to SBHCs.
In addition to the joint leadership of your agencies in developing the toolkit and letter, we
were pleased to see strong recognition of the health and education link from Congress,
through recent passage of the Every Student Succeeds Act (ESSA). This legislation will provide
schools and community partners with new tools to support healthy students and promote
healthy and safe school environments. As the Department of Education begins to implement
this law, school districts are seeking guidance and leadership from your agencies to execute
community partnerships to bolster student health. SBHCs are eager to partner with schools to
deliver such programming, and are poised to address priority health issues identified in this
legislation, including substance abuse, mental health, violence, healthy relationships,
nutrition, and physical activity.
We look forward to working with your agencies to advance student health and remove
barriers to care, documenting quality, and reimbursement for school-based health centers. At
your convenience, we would like to further discuss our opportunities for collaboration. We
appreciate your consideration of this request.
Sincerely,

John Schlitt
President
School-Based Health Alliance