MDH outlines plan to expand school-based health centers, push billing and sustainability

The Maryland Department of Health told the House Health and Government Operations Committee that it is pursuing a multi-part plan to grow and financially sustain school-based health centers (SBHCs) across the state, increase billing capacity, and standardize quality reporting.

Deputy Secretary for Public Health Nilesh Kalyanaraman and Dr. Ben Wormser, medical director of the Maternal and Child Health Bureau, said the program moved from the Maryland State Department of Education to MDH in 2022 and that $6.5 million in Blueprint funding was allocated to support expansion and operations.

Key facts and figures

- Scope today: MDH said there are 89 school-based health centers in 16 counties, serving students in 161 ZIP codes. MDH reported 30,000 clients enrolled in SBHCs, of whom about 20,000 used services, generating roughly 48,000 visits (17,000 students and more than 3,200 non-students).

- Financial sustainability and billing: MDH said it is building a sustainable financial model for SBHCs by improving billing practices, especially Medicaid billing and revenue-cycle management. The department updated its billing manual, changed regulation to permit Medicaid reimbursement for sports physicals, and disaggregated provider IDs to track where billing originates within centers. The department said Medicaid accounts for 39% of SBHC clients, uninsured patients 35%, and the remainder privately insured (presented by Dr. Wormser).

- Grants and site expansion: MDH approved 14 new candidate sites for SBHC status and issued two-year planning grants to support infrastructure and staffing; MDH has awarded four planning grants to date and aims to get 8 to 14 of the 14 approved sites up and running over the next two years. The department also described an onboarding institute to provide technical assistance and peer learning for new sites.

- Quality standards and data: MDH updated SBHC standards in coordination with national support organizations (NASBHC and CASBHC) and is finalizing those standards. The department has produced its first individualized site profiles, released an annual report, and convened a learning collaborative for existing centers. Data and reporting improvements are intended to track operations, quality and value.

Questions and details requested by the committee

Committee members asked about payer mix; Dr. Ben Wormser said Medicaid makes up 39% of SBHC clients, 35% are uninsured and the remainder privately insured. Members also asked whether SBHCs must collect insurance information at enrollment or at point of care; MDH said enrollment packets and other mechanisms (QR codes, phone follow-up) are used and procedures vary by site.

MDH said it would continue to work with federally qualified health centers to leverage enhanced Medicaid funding and with local jurisdictions to reopen or stand up centers where necessary. MDH noted that some counties (for example Prince George's) have been working with local school systems to reopen SBHCs previously managed by the county school system; MDH awarded at least one planning grant to Prince George's Public Schools.

Ending: MDH officials asked for continued partnership with the Legislature and local jurisdictions to support contracts, billing capacity and site start-up. The department said it will provide further details and reports as planning grants mature into operating clinics.