CHC School-Based Health Centers Grow, Expanding Essential Access to High-Quality, Low-Cost Care

The nation’s community health centers (CHCs) play an essential role in caring for children, providing primary care as well as related services including behavioral health and dental care in low-income and medically underserved communities. In 2024, CHCs served 9.4 million children and teens under age 18, or about 1 in 8 U.S. children. Nearly three quarters (73%) were covered by Medicaid or CHIP, while 12% were uninsured. (HRSA, Uniform Data System 2024). CHCs offer comprehensive services including primary care and crucial early screening for disabilities and developmental delays that helps facilitate timely intervention and care plans, and can lead to better long-term health outcomes (American SPCC, n.d.). These services can help children to succeed in school. However, many barriers prevent regular access to care for school-aged children including cost, time, and transportation (Soleimanpour, 2020). School-based health centers (SBHCs), located in school settings, play a significant role in facilitating access and bridging gaps in care. Schools provide a convenient setting for health services, especially for underserved children and adolescents who are otherwise hard to reach (Soleimanpour, 2020).

SBHCs date back to the early 1900s, as part of an effort by the New York City Board of Health to contain contagious diseases. The school nurse role was created to provide health education and care to children, reducing absenteeism by nearly 90% in one year (Keeton, Soleimanpour, and Brindis, 2012). Over the next fifty years, the role of the school nurse expanded. In the late 1960s, Dr. Phillip J. Porter, then head of Pediatrics at Cambridge City Hospital (Cambridge MA.) led the establishment of pediatric neighborhood health centers to care for underserved children. Four of five clinics in the program were located in public elementary schools (Keeton, Soleimanpour, and Brindis, 2012; Porter et al 1976); these were the first school-based health centers (Gustafon, 2005). Throughout the 1970s and 1980s, similar health centers opened across the country as awareness of the model, and the disparate health status of low-income children and adolescents, took hold. With the support of private philanthropy including key investments by the Robert Wood Johnson Foundation, as well as state support, the number of SBHCs increased three-fold in the 1990s. Nationwide Medicaid expansions phased in under the Omnibus Budget Reconciliation Act of 1990, which extended coverage to school-aged children ages 6-18 whose families had incomes below 100% of the FPL (Love et al., 2019; MACPAC, 2025), fueled both access and the increase in sites.

Today, schools with SBHCs serve more socially and economically disadvantaged youth than schools without SBHCs (Soleimanpour, 2020), and an estimated 7 in 10 students who attended schools with SBHCs were Black, Indigenous, and people of color (School-Based Health Alliance, 2023). SBHCs serve primarily children covered by Medicaid and CHIP (MACPAC, 2025). In 2024 CHC grantee-operated SBHCS served nearly 1.2 million children, an increase of 80% from 2020 (Figure 1). The number of school-based sites operated by CHC grantees increased 44% from 2020-2024 to 4,367 sites (Figure 2) (HRSA, Uniform Data System). Additionally, the number of SBHCs operated by CHC look-alikes (community health centers that do not receive federal § 330 funds) increased 4-fold during this period. A 2022 survey by the School-Based Health Alliance estimates that just over 60% of all SBHCs are operated by community health centers.

Figure 1

Source: HRSA National Health Center Program Uniform Data System, 2020-2024

Figure 2

Source: HRSA National Health Center Program Unifrom Data System, 2020 and 2024

SBHCs now offer a variety of services that include primary care, behavioral health, vision, and dental care through partnerships with health care organizations, allied schools and community organizations (School-Based Health Alliance, 2023). In addition to providing convenient access to vital high-quality healthcare services, SBHCs help improve academic performance, and their presence has contributed toward reduced absenteeism and increased graduation rates (School-Based Health Alliance, 2023).

SBHCs are operated by CHCs across the country. We reached out to CHC colleagues in New York, where more than 40% of all CHC grantees operated school-based sites at over 200 locations in 2024. Mary Zelazny, CEO of Finger Lakes Community Health or FLHC (Penn Yan, NY) explained that the health center began providing dental care in schools in 1991, traveling to schools serving migrant children In 2023, FLHC opened its first fixed school-based health center site. In addition to offering medical and behavioral health visits, the program provides popular onsite dental service. Eight months after opening, FLHC was advised by the school board that absenteeism had dropped, which they attributed to the SBHC. About two-thirds of the school's students are registered at the SBHC and many school families are FLHC patients, keeping the whole family’s healthcare in the same system. In 2025, the program served an estimated 2,200 children at 74 schools. Zelazny noted that children feel comfortable and are easy to reach when they are at school, making SBHCs one of the best ways to serve them, especially in FLHC’s rural service region.

ConnextCare (Oswego County, NY) operates a SBHC program at 9 schools in six districts, serving 90% of the children enrolled from Pre-K through 12th grade, According to CEO Tricia Peter-Clark, they provided nearly 25,000 medical visits, 6,300 mental health visits, and 3,000 dental visits through the school program in 2024. Peter-Clark noted that SBHCs help reduce barriers to care for students, while helping them build good health habits. The students are able to get care regardless of their insurance status, and without barriers such as transportation and parents’ scheduling limitations. Additionally, clusters of sick students can be readily identified, so that measures can be put in place to contain the spread of illness. The availability of on-site school-based care has other benefits, too: since ConnextCare opened their newest site, the school has seen significant improvement in both chronic absenteeism and the number of consecutive days students are absent.

School-Based Health Centers provide an important access point for children and adolescents, allowing them to benefit from timely, affordable medical and behavioral healthcare services. Having a health center on the school premises helps students stay engaged and reduces absenteeism. Their growth in recent years is a positive sign of advances in access, increasing available services, especially for vulnerable youth and those in rural, hard to reach communities. With looming Medicaid cuts threatening underserved communities and the CHCs that serve them, advocating for investment in the SBHC model, and strengthening CHC funding is critical.

This article was published in 2026.

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