Friday, September 20th, SBHCs received emails from their DOH program managers with a message from OHIP announcing a plan to transition SBHCs into the State’s Medicaid Managed Care program as of April 1st 2025. The letter stated the following:

Effective April 1, 2025, School Based Health Center (SBHC) services will be included in the Medicaid Managed Care (MMC) benefit package. New York State recognizes that SBHCs are a critical source of primary care, urgent medical care, and dental care for school-age children. The transition of SBHCs into the MMC benefit package will strengthen and improve the coordination of care, quality of care, and outcomes for children. For a minimum of two years following the inclusion of SBHC services in the MMC benefit package, MMC plans will be required to pay no less than Medicaid fee-for-service (FFS) rates for SBHC services. Along with a 10% increase in SBHC reimbursement rates enacted in the State Fiscal Year 2024 Budget, the Department will build on the work accomplished to date and will continue to engage with SBHCs, MMC
plans, and stakeholders towards completion of a successful transition. We look forward to continued collaboration. Please submit any questions to omcmail@health.ny.gov.

School-based clinics have been carved out of managed care since 1997, enabling them to receive reimbursement directly from the State on a fee-for-service (FFS) basis. NYSBHA supports the legislative bills S.7840, Rivera/A.8862, Paulin, which passed in both Houses this year with the aim to make the SBHC carveout permanent.

See NYSBHA’s letter to Governor Hochul detailing our concerns with managed care: SBHA A8862 S7840 Gov Hochul Ltr
Read Senator Rivera’s Statement in response to the transition announcement
Legislative bills: S.7840, Rivera A.8862, Paulin

Visit our Alliance Advocacy Center for more information or contact NYSBHA directly: nysbha@gmail.com.