Schools play a leading role in providing healthcare, well beyond offering flu shots and bandages. Millions of children across the country rely on school-based health services for preventive and ongoing care, including mental health counseling and management of chronic illnesses such as asthma and diabetes.
These services are delivered by a range of healthcare professionals, including school nurses, psychologists, physical therapists and speech-language pathologists.
School-based healthcare can be provided at school or school-based health centers, or through partnerships with local health organizations.
School health services have been shown to reduce health disparities and improve school attendance. Yet many inequities exist; more than half of public schools, for instance, do not have a full-time nurse or school counselor, and less than 5 percent of U.S. students have access to services through a school-based health center.
All children benefit from access to healthcare. For children with Medicaid coverage — who have higher rates of chronic health issues and face greater barriers to seeking care — school health services are especially important for early diagnosis, treatment and effective management of chronic health conditions, as well as for preventive care they might not receive elsewhere.
Why Schools Deliver Healthcare
Between the ages of 5 and 17, children spend about six hours per day at school.
For this reason, it makes sense for schools to be a delivery point for health services. Providing healthcare where children spend a majority of their time makes it more accessible for students and their families, as it eliminates the need for transportation and scheduling.
School-based healthcare is free at the point of service, and students receive access to care that might not be received elsewhere. Nearly 80 percent of children who receive behavioral services access them at school.
To meet the needs of students, schools must have sufficient funding to cover the cost of delivering health services. State Medicaid programs are not the only source of funding for student health services, but they do play a critical role in increasing the stability of school health programs and improving access to student health services.
In 2014, the Centers for Medicare & Medicaid Services (CMS) expanded the use of Medicaid to pay for school-based health services for all Medicaid-enrolled students, instead of covering only students with disabilities who received health-related services as part of their special education plan.
At first, states were slow to implement this change, even though it could potentially reap dividends for school districts. Many states had codified the original policy in their Medicaid state plans, which meant they would have to update the plan.
Another barrier identified is the challenge of identifying the types of personnel who can meet the licensure, training and education requirements often tied to Medicaid reimbursement. Ensuring alignment across state education/other agency standards and Medicaid requirements for school health personnel is critical to helping schools maximize reimbursement. (View the School Medicaid Programs map to learn more about school health services eligible for Medicaid reimbursement and the types of eligible providers in your state.)
As of October 2023, more than two dozen states have increased access to school health services through Medicaid reimbursement — and much has been learned about what it takes. There are best practices for organizing and advancing policy; for how to design the administrative processes; and how to tackle other big obstacles to improving student access to care.
By focusing on Medicaid-funded school-health services, Healthy Students, Promising Futures provides a unique glimpse into building a sustainable funding structure and offers concrete lessons for collaboration among agencies.