New research from Whitman College highlights the unique ability of school-based health centers (SBHCs) to provide health care for underserved, low income and minority youth. Yet these clinics face funding difficulties partly because they cannot bill insurance providers. Our study makes the case for how and why Washington should support SBHCs through policy reforms. Community Partner: The Health Center at Lincoln High School.

Download Executive Summary (PDF) | Download Final Report (PDF)

Topic: This report demonstrates the value of school-based health centers (SBHCs), provides a comparative study of SBHC policy throughout the nation, and makes the case for policy reforms to put SBHCs on more solid financial footing in Washington State. We worked in partnership with Holly Howard and Katherine Boehm, the Executive Director and Director of Clinic Operations respectively, at The Health Center (THC), a SBHC at Lincoln High School in Walla Walla, WA.

Methods: Using THC as a case study, we evaluated the effectiveness of SBHCs in reaching underserved youth. To do so we interviewed students, teachers and staff about their experiences using THC and its impact on students. We framed this study with prior research addressing the specific barriers to care youth face accessing health care. Knowing that THC struggles financially, we conducted statistical analysis of THC’s demographics and potential billing revenue. To understand the current environment for SBHCs in Washington, we analyzed the state’s health care policy. Finally, informed by previous studies highlighting the importance of state support for SBHCs, we analyzed SBHC policies in seven other states (OR, CA, NM, CO, IL, MD, NY). We synthesized our findings to determine policy options for strengthening SBHCs in Washington.


  • SBHCs improve access to care for underserved children, create healthier kids and transform student lives and academics.
  • Billing revenue can provide additional and needed funding for SBHCs.
  • Washington State currently does not support SBHCs in law or policy, though it does make a commitment to insuring all children as well as serving the health care needs of racial minority, low income and other underserved populations.
  • Nineteen U.S. states do fund SBHCs and include them in their law and policy, and these SBHCs are more sustainable and better integrated into the health care network.
  • States best support SBHCs by providing direct grants and regulating SBHCs’ relationship with Medicaid so that the clinics can bill for services they provide.
  • Requiring providers of Medicaid insurance to reimburse SBHCs will improve spending efficiency for Washington State’s government.

Action Recommendations

  • Washington State legislature and Department of Health: define SBHCs in public law and policy and license eligible clinics.
  • Washington State: provide direct funding to SBHCs to improve care for underserved kids.
  • Health Care Authority: implement a mandated contract model regulating SBHC-Medicaid relationships, requiring Medicaid insurance providers to include SBHCs in their networks.
  • Washington’s citizens: lobby local and state governments to adapt these policies
  • Washington’s communities: encourage the growth and sustainability of SBHCs–donate, volunteer, or support local clinics in whatever way possible.

Download Final Report / Contact Kate McMurchie at [email protected]

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