School-based clinics provide important access to health care for adolescents. For the past 20 years in St. Paul, Minnesota, Health Start has been a nonprofit organization providing comprehensive primary care services in the city's public high schools. Over the past decade, Minnesota has seen the growth of managed care plans for both the private and public (Medicaid) sectors. For the past several years, Health Start has been building relationships with managed care plans in order to coordinate care for adolescents. Since managed care plans differ in their management, reimbursement, and service delivery methods, Health Start has developed several models of partnership with managed care plans for the delivery of primary care to adolescents enrolled in school.