OBJECTIVE: This study was designed to measure the cost benefit of the School-Based Health Centers (SBHC). METHODS: Four SBHCs (3 urban and one rural) plus four comparison school districts were studied from 1997 to 2003. A total of 5,056 students who enrolled in six schools and the Ohio Medicaid program were evaluated to assess the value of health status change. Parent's survey was conducted to assess the potential benefit for families. SBHC coordinator's survey was conducted to document the operational costs and benefits. Cost-benefit analysis (CBA) was conducted to estimate the value of resources used by the SBHCs compared to the value of resources the program might save or create. RESULTS: During the first three years of operation, the total cost for four SBHCs was $1.5 million. The savings from health improvement included $228,144 from students with asthma, $594,228 from prescription drug use, $42,956 form travel expense, and $542,761 from parent's productivity. The value of health status changes involved $771,840 for mental health care, and $51,672 for dental care. The benefits of four SBHCs ranged from $2.72 to $5.99 million. CONCLUSIONS: From a societal perspective, the four SBHCs were cost beneficial with a net social benefit from $0.71 to $3.98 million over the first three year of operation. The SBHCs were cost beneficial in a societal perspective.