BACKGROUND: The patient-centered medical home (PCMH) is promoted as a way to improve access to care, health care outcomes, and control costs. The organizational, environmental, and patient characteristics associated with school-based health centers (SBHCs) obtaining PCMH recognition is currently unknown. A multitheoretical approach was used to explore the correlates of formal PCMH recognition in SBHCs. METHODS: The 2013-2014 National Census of School-Based Health Centers was used as the primary data source for this analysis. Multivariable logistic regression was used to assess the odds of an SBHC obtaining any type of PCMH recognition, and obtaining national PCMH recognition. RESULTS: Only 29% of SBHCs had received any type of recognition as a PCMH and 17% reported receiving national-level recognition. School-based health centers that were managed care preferred providers, received Health Resources and Services Administration SBHC Capital Funding, and based in schools without adolescents had greater odds of both types of PCMH recognition outcomes. High levels of revenue from patient billing and more staff were also associated with national PCMH recognition. CONCLUSIONS: Financial and personnel resources are needed for national-level PCMH recognition, and managed care is supportive of PCMH implementation. Efforts should be made to increase medical home activity in SBHCs that serve adolescents.