Medicaid Cuts Could Lead to Increases in Chronic Absenteeism

August 14, 2025

By Jeffery Huang, Public Policy Intern

“Medicaid cuts …will lead to an uptick in absenteeism, disciplinary issues (due to unmet needs), and need for alternative options. For students with mental/behavioral health needs but without family support, incarceration is more likely. This increases costs to our community.” —Director of Student Support Services, Wisconsin (Rural District)

With Medicaid cuts expected to reach nearly $1 trillion over the next decade, schools will have less funding and fewer resources to address a significant public health issue: chronic absenteeism.

More than 1 in 4 children in the U.S. are chronically absent from school, meaning they miss 10% or more of the school year. Students who are chronically absent in elementary school are less likely to be reading at grade level; in middle school and high school, they are at an increased risk of academic failure, disengagement and graduating on time.

Chronic absence also has spillover effects on classmates’ achievement outcomes, due in part to slower instructional pacing and diminished expectations around attendance.

Mental and physical health challenges, including chronic illnesses such as asthma and diabetes, are among the leading causes of chronic absence. Providing health services within the school environment, including through school-based health centers and telemedicine, has been shown to improve both student health and school attendance.

Earlier this year, when Medicaid cuts were first being discussed in Congress, Healthy Schools Campaign surveyed school district leaders about the impact of reduced Medicaid funding on student health. HSC’s report includes analysis and comments from more than 1,400 school administrators, Medicaid coordinators, health providers and school support staff from all 50 states and D.C.

Some respondents predicted that cutting Medicaid would lead to poorer health outcomes, due to a reduction in school health staff and services, and this, in turn, would result in increased chronic absenteeism. Here are some responses:

• “One of the most immediate consequences would be decreased access to school-based mental health services, including counseling, therapy, and behavioral intervention. With fewer school counselors, social workers, and behavioral specialists available, students who need these supports may face longer wait times or receive less frequent care. As a result, students struggling with anxiety, depression, PTSD, or other emotional disorders may experience declining academic performance, increased absenteeism, and a higher risk of dropping out.” —Executive Director of Student Services, Georgia (Rural District)
• “These cuts could lead to staff reductions, making it difficult to maintain the level of care and support we currently provide. Additionally, we risk losing essential technology, equipment, and resources that are vital for the delivery of quality education and health services. Ultimately, the cuts would undermine our ability to meet the diverse needs of our students and create long-term challenges for their health and academic success.” —Medicaid Coordinator, California (Suburban District)
• “Students access school services in partnership with local agencies; cuts to Medicaid mean less services, accessing them after school instead, or missing school for them.” —Speech-Language Pathologist, Arkansas (Suburban District)

Respondents also shared the ways in which Medicaid cuts will affect social drivers of chronic absenteeism, such as family and emotional stress, economic insecurity, substance use, housing instability, immigration status and lack of access to transportation. Examples are noted below:

• “Cuts could leave these families unable to afford private therapy or medication, leading to untreated conditions. Without Medicaid coverage, some families may have to forgo care altogether, causing mental health challenges to escalate. Untreated mental and behavioral health needs can lead to increased disruptive behaviors, absenteeism, and difficulty maintaining peer relationships.” —School Social Worker, Michigan (Rural District)
• “The immediate impact will be seen in their behavior, grades, and attendance, resulting from not having the support to work on their mental health challenges.” —Counseling Therapist, California (Suburban and Rural Districts)
• “A majority of the population of families in my district have hardships getting the support their child needs due to long commutes for work, limited public transportation, and other social support. Since the child can be transported back and forth to school and health-related services [are provided] during this time, we are able to get children the care that is medically necessary for them to become contributing members of society. Without this program, the children will most likely not get the level of care they need.” —Medicaid Coordinator, Pennsylvania (Suburban District)

A new report, “All in for Attendance: Collective Action for Public Health Strategies That Address Chronic Absence,” developed by Attendance Works, Johns Hopkins Center for Public Health and Kaiser Permanente, aims to establish chronic absence as a public health concern, rather than solely an educational issue that focuses on individual behavior.

It describes chronic absence as a public health signal that “can be used to reveal where students are falling through the system cracks and prompt coordinated, preventive responses,” and identifies three guiding principles for preventing absenteeism, with actionable items under each one. Here’s a summary of the principles:

The report encourages cross-sector partnerships and data-driven decision-making. Recommendations include establishing consistent measures and definitions for chronic absence, as well as incorporating school attendance and chronic absence into public health needs assessments.

Additionally, it explores how the health and education sectors can collaborate to address attendance barriers, highlighting best practices and lessons learned from the recently updated “Health and Education Partnership Playbook.”

Collaboration with partners across sectors, particularly across health and education systems, is essential for reaching data-informed solutions. State agencies and school districts will need to work together to mitigate the harms of cutting Medicaid and to ensure the health and well-being of students, schools and communities.

Cross-posted at HealthySchoolsCampaign.org