BROOKLYN — School-based health clinics across the city are under threat and facing potential closure or serious staff shortages because of Albany’s budget cuts and a change in the State Department of Health's funding formula.
Contracts for the city’s largest providers of school-based clinics have been slashed — some up to 70 percent — at a time when the city is elevating the importance of providing access to health services at schools, making on-site health clinics the centerpiece of its “community schools” model that aims to improve attendance and performance of high needs students.
No medical center in the city has officially confirmed closures for the fall, but many are bracing for a big impact for these clinics, which are overseen by a certified physician and have, at minimum, a nurse practitioner, who can administer medicines and write prescriptions for students free of charge, regardless of insurance status.
"It is having a devastating effect on the field," said Sarah Murphy, of the New York School-Based Health Alliance, noting that New York City, which has more than 60 percent of the state's school-based health clinics, has become a model for the nation in providing this kind of care.
"Not only is New York leading the way in terms of strength and size and innovation, but also steering the course for the nation," Murphy said. "It boggles the mind why the state is not behind this. We had actually asked for an increase in funding and instead got the largest decrease in the history of the field."
East Harlem’s Mount Sinai Medical Center — which runs clinics at the Upper East Side’s Julia Richman educational complex and the Upper West Side’s Brandeis and Martin Luther King campuses — is being cut more than 60 percent from $1.136 million to $439,000, according to data obtained from the state health department.
Brooklyn’s Lutheran Medical Center, which runs nearly 19 clinics — including at South Slope’s P.S. 10 and P.S. 124 and Sunset Park’s P.S. 24 — is facing a cut of more than 44 percent from $1.2 million to $673,000.
The Bronx’s Montefiore, which has the largest school-based program with 23 clinics — including at the high school campuses at DeWitt Clinton, Evander Childs and Lehman — is being cut nearly 27 percent from $1.12 million to $858,000.
The fate of the four clinics, run by SUNY Downstate Medical Center, is unknown as its grant for school-based clinics is being cut from nearly 70 percent from $669,000 to $198,000.
"In the landscape of health care in New York, we're very small," Murphy said. "But for the small piece we are, we are doing great work. We are a proactive and preventive field. We are keeping kids out of emergency rooms."
Most of the services the students get at these clinics would not be obtained elsewhere, according to health data, Murphy said, noting that many of these clinics serve the city's neediest students.
"They're not going to get health care somewhere else. It's the one time where kids can self refer and get help, and parents don't have to lose a day of work," she said.
One-third of visits to these clinics are for mental health, and those are the services that will most likely be cut first, Murphy added.
Also, while the biggest providers are being hit this year, because the new methodology as it relates to Medicaid funding makes the landscape less stable, she believes the smaller providers could also be hit hard next year.
Medical centers were only recently informed of the cuts that took effect on July 1, said Rebecca Gallagher, senior director of youth and adolescent services for the Family Health Centers at NYU Langone, which oversees Lutheran’s clinics.
They are actually adding two new clinics at the city’s “community” schools in Carnarsie and Williamsburg that come with operational funding from the city.
But there are still many question marks, which is why they joined a coalition with the Greater New York Hospital Association to advocate for more funding and look for it, whether from private donors, the city or elsewhere.
“We’re leaving no stone unturned,” Gallagher said. “We’re really in the process now of figuring out how we can make school health sustainable. Losing funding is never a good thing, but it’s especially bad timing: we’ve been asked to expand, the status of Medicaid is a little if-y, other grants are being cut."
A recent letter SUNY Downstate officials wrote to the principals at Carroll Gardens’ Brooklyn New School and the Brooklyn School for Collaborative Studies — who share a building and clinic — said they planned to call on the City Council for emergency funding.
“If funding is not obtained,” according to the June 15 letter from SUNY Downstate directors, “the hospital will be forced to make hard choices regarding how best to provide services for the sites we sponsor with the limited state funds available.”
Parents at the Henry Street schools are now organizing to save the clinic, which they feel is vital to their communities, seeing more than 3,380 patient visits last year, according to school data. Roughly 50 percent of the students the clinic sees qualify for free or reduced-price lunch.
The clinic’s nurse practitioner is able to do things that a typical school nurse can’t. Besides diagnosing ear infections, pink eye and strep throat, she can also prescribe medication if needed. She administers flu shots, gives pain relievers for menstrual cramps, provides medicine for asthma attacks and conducts physicals for sports teams and camps.
Also, the clinic provides reproductive care to older adolescents, who may not otherwise have access to that assistance.
When contraception was introduced at this clinic and 43 other high schools a few years back, there was a 40 percent reduction of teen pregnancy rates within two years, according to the schools.
Brooklyn New School parent Rachel Benoff has come to rely on the care her daughters receive at the clinic for ailments like ear aches or tummy aches. It allows the public school teacher to stay at work with her 25 students while her girls need medical attention. It allows her daughters to barely miss class, she said.
“There’s a real economic impact when parents miss work. My kids feel like if they’re not feeling well, they have a relationship with a practitioner,” Benoff said. “From the perspective of a teacher, it’s so important that kids have seamless access to health care. It really impacts their ability to function in the classroom.”
SUNY Downstate took over the clinic at the Carroll Gardens schools, along with three others, eight years ago from the now-closed Long Island College Hospital (LICH) — after families rallied to save it.
Parents are hoping they help once again and have been reaching out to their elected officials.
“These are the things we fought for and saved when LICH closed,” State Rep. Jo Anne Simon said.
“In the big budget discussions in Albany,” she added, “there are lots of little pieces and a lot of those little pieces have big importance in people’s lives.”
Many programs have been cut significantly, including smaller ones run by the Bedford-Stuyvesant Family Health Center, East Harlem Council for Human Services and Jamaica Hospital.
At the same time, however, the state is increasing funding to some programs to start clinics, including Elmhurst Hospital, which is getting more than $147,000 and Harlem’s Heritage Health Care Center.
Under the state's updated formula, grants for the school-based clinics are awarded to reflect criteria such as enrollment, number of sites, and an alternative source of funding, NYS Department of Health officials explained.
City Councilman Brad Lander and State Sen. Daniel Squadron, whose districts also include BNS and BCS, are working on a petition to rally support to save the clinics.
“I’m deeply concerned about the loss of funding for these clinics in my district and beyond,” Lander said. “These school-based health centers are critical safety-net providers for students in our local public schools and provide greatly needed treatment to every child that enters their doors, regardless of their ability to pay.”
Department of Education officials are also trying to find solutions.
“School-based health clinics provide critical resources for students and families," DOE spokeswoman Toya Holness said, "and we are working closely with medical providers to ensure school communities continue to have access to these services."
The chart below shows the medical centers that run school-based health clinics and their state funding last school year compared to the coming school year. (Note: The Research Foundation of SUNY is the funding for SUNY Downstate.)