Module 2: Financing a Clinic

Sustainability is Key

Successful school-based clinic financing is based on multiple factors. This often consists of a diverse portfolio of funding types, including:

Billing revenue
Other public (or private) funding

Billing insurance is the #1 way to bring in revenue for school-based clinics. Resources below may help clinics in getting organized on billing or supporting patients with enrollment into insurance or payments.

Medicaid / HealthFirst Colorado -- Colorado Department of Health Care Policy and Financing (HCPF) oversees HealthFirst Colorado, the state's Medicaid program. Colorado contracts with Regional Accountable Entities (RAEs) to manage Medicaid locally. A relationship with the RAE(s) serving your patient population is key to success. Know who your RAE contact is, what supports are available, and contract details specific to your clinic to support revenue. School-based clinics are encouraged to support patients, directly or through referral, with Medicaid enrollment processes. Partnerships with your RAE can further enhance your ability to help families enroll.

Billing Manuals -- HCPF maintains billing manuals for a variety of service focus areas. All manuals can be access through HCPF's website. A few with high relevance to school-based clinics are linked below.
- State Behavioral Health Services Billing Manuals
  - (Capitated Behavioral Health Benefit) State Behavioral Health Services Billing Manual (updated quarterly) – Managed through the state’s Regional Accountability Entities
  - Fee-for-Service Behavioral Health Benefit Billing Manual (7/26)
- Telehealth and eConsult Billing Manual (updated July 2026)
- Screening, Brief Intervention and Referral to Treatment (SBIRT) Program (updated July 2026)
- Integrated Care Sustainability Policy
  - The Colorado Department of Health Care Policy and Financing (HCPF) implemented the Integrated Care Sustainability Policy in July 2025, which included opening select HBAI and CoCM billing codes and also a directed to all psychotherapy services provided in primary care stings to be billed to RAEs under the state’s capitated behavioral health funding, sunsetting the 6 Short-Term Behavioral Health Visits in Primary Care policy.
Cover All Coloradans -- a Medicaid/CHP+ program available for immigrant pregnant people and children without documentation as January 1, 2025.

Connect for Health Colorado is the state’s private plan marketplace with premium assistance for qualifying individuals

OmniSalud is a connection to private plans for individuals without documentation

Billing for confidential services -- Many clinics have to consider how to maintain patient confidentiality while delivering services. This document is a suggestion on how to handle billing in these situations.

Exemptions for copays & deductibles -- Colorado law exempts school-based clinics from having to collect copayments and deductibles before billing insurance. This document reviews the law and considerations for clinics.

Billing Revenue

Privacy

Other Funding Sources

Listed below are public funding sources clinics may want to consider for their program:

School Based-Health Center Program, Colorado Department of Public Health and Environment – general operating and planning grants available regularly
Colorado Primary Care Fund, Colorado Department of Healthcare Policy and Financing – funding to support clinics that serve uninsured who may not qualify for any other program

Outside of public funding, local and statewide private foundations may also be a resource. Please check with Youth Healthcare Alliance staff to get the most current ideas and connections.

MODULE 1

Managing a Clinic

There are specific nuances that make managing a school-based clinic different than running other types of health clinics. While all require similar skills and knowledge, school-based clinics are located on school grounds and are youth-serving, so a working knowledge of HIPAA and FERPA requirements, minor consent laws, and engagement with schools and school districts are necessary. It is also critical to promote safe, inclusive spaces to receive care, which begins with management structures. Resources in this module include:

Clinic welcome packet
Quality standards and clinic menu of services
Patient privacy, confidentiality, HIPAA/FERPA
Marketing, recruitment, and retention
Evaluations

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