School‑Based Health Care Benefit Expansion effective May 1, 2025

School‑Based Health Center (SBHC) and SBHC‑Dental (SBHC‑D) services will transition into the Medicaid managed care benefit package for Anthem members effective May 1, 2025. This transition aims to maintain access to these essential services while improving quality, efficiency, and outcomes. 

SBHCs provide or make available comprehensive primary medical, dental, social, mental health, and health education services designed to meet the psychosocial, physical, and dental needs of children and youth within the context of the family, culture, and environment, including:

• Primary healthcare services at the SBHC including comprehensive health assessments, and diagnosis and treatment of minor, acute, and chronic medical conditions
• Dental services including oral health assessments, primary and preventive dental care, and oral health education.

SBHC services will transition over a two‑year period and as part of the continuity of care plan, concurrent review authorization or retrospective utilization review will not apply. Anthem will allow members to continue ongoing treatment at SBHCs for six months after the transition without changes.

For detailed guidance or a listing of the SBHC programs in your county, please refer to:

• The NYSDOH Medicaid Redesign Team’s SBHC Policy Document:
• Transition of School Based Health Center Benefit and Population into Medicaid Managed Care
• The NYS SBHC Billing Guidance:
• NYS Mainstream Medicaid Managed Care and School Based Health Center Billing Guidance
• SBHC Program Directory:
• health.ny.gov/facilities/school_based_health_centers/docs/sponsor_directory.pdf

For questions or more information, contact Provider Services at 800‑450‑8753.