Partnering Medicaid managed care and school-based health centers: Results from a pilot project in Los Angeles

INTRODUCTION - In order to improve access to care for underserved children, L.A. Care Health Plan (a non-profit Medicaid managed care organization serving Los Angeles County, California) implemented a pilot project to assess the impact of reimbursing local school-based health centers (SBHCs) for delivering primary care services to plan members.

METHODS - Fourteen local school-based clinics participated in the nine-month pilot to assess the type and volume of services that SBHCs can deliver to children. Claims data and pilot site questionnaires were analyzed to identify and reduce administrative barriers experienced in the pilot.

RESULTS - SBHCs submitted a total of 644 claims representing 340 individual members. Preventive care was the most common service (46% of claims). A small number of students (22%) received a duplicate service from their primary care provider. SBHCs reported several administrative challenges including executing the contract (57%), identifying the child's insurance status (100%), establishing a system for submitting claims (57%), and communicating with the primary care provider (100%). Clinics with strong administrative infrastructures submitted the most claims and reported the fewest administrative challenges.

DISCUSSION - Despite some duplication of services, SBHCs are potentially important sites for delivering preventive care to low income, managed care members. Several steps can be taken to address administrative barriers encountered when SBHCs work with managed care organizations including using a steamlined contract template, assistance in creating billing infrastructure in the SBHC, collecting insurance information for students on parental consent forms, and facilitating coordination of care between SBHCs and primary care providers.