Advocating For Healthy Schools: Interview With Alex Mays

Healthy Schools Campaign is bidding a fond farewell to Alex Mays, senior national program director, as she embarks on a new journey related to school health. Over the past 12 years, Alex has impressed many people with her policy knowledge as well as her enthusiasm and commitment to the health and wellbeing of children and their communities.

I met Alex when she interned at HSC as a graduate student and then watched her grow in her knowledge, analysis and organizing skills into a respected leader in the school health field. It has been a privilege to work with her, support her and learn from her. Her effective advocacy for policy changes will have a lasting impact on schools across the country.

Alex recently talked with HSC about how the idea of a “healthy school” has changed over time, building bridges between education and health sectors, and her new position at Kaiser Permanente, where she’ll have the opportunity to put into practice much of what she advocated for while working with HSC. We can’t wait to see what she accomplishes next.

– Rochelle Davis

HSC: Ideas about what makes a “healthy school” have shifted over the past decade. What did it mean when you first started at HSC, and what does it mean now?

Alex: The “Whole School, Whole Community, Whole Child” model, which used to be referred to as “coordinated school health,” identifies buckets of school health and wellness – food, fitness, environmental health, school health services – and that framework became a helpful way for people in the field to talk about “healthy schools.”

Now, there’s recognition that while it is all those things, it’s not about the pieces – it’s how you build the system. It’s how you create an environment that’s supportive, and how you put in place policies and programs that are not necessarily issue-specific but can provide the funding and accountability. It’s about creating opportunities that enable a community to implement programs that meet whatever their health needs are.

That’s what I’ve always loved about Healthy Schools Campaign, because that’s been the north star in our work. We don’t want to be an issue-specific group; we want to advocate for the policy and systems change that ensure any community can implement the programs they need to meet the unique health needs of their students.

I think the field is moving in that direction and thinking more holistically. We recognize health and learning are key, but now the question is: How can we embed health and wellness within assessments, within accountability, within professional development and within funding, instead of ending up with one-off programs that do really good work but don’t treat the child as a whole?

HSC: That’s a great way of summarizing the move toward systems change. How did that shift impact your work over the last decade-plus?

Alex: So much of what I do is based on that notion of: How can we support the inclusion of health and wellness within education, and how can we better align these huge systems to support health and wellness?

I interned at Healthy Schools Campaign when I was in graduate school and worked on our school nurse leadership program for a summer, which focused on providing school nurses with leadership skills to be champions for health and wellness. The program sparked questions: Why aren’t there more school nurses? What are the limitations to funding the work they’re doing?

In 2012, we published “Health in Mind,” a report that presented system-level opportunities to support health and wellness, and held an event with then-Education Secretary Arne Duncan and Health and Human Services Secretary Kathleen Sebelius. Developing that report, and embracing advocacy goals as an organization, shaped my work going forward. It was at that time that the question of billing Medicaid for school health services came up repeatedly, and I dove in on it.

HSC: For readers who have not attended one of your webinars on school Medicaid, your work has involved helping states take advantage of a 2014 federal policy shift, which allows reimbursement for all health services provided to all Medicaid-enrolled students. What were the most rewarding parts of that work, and what challenges did you face?

Alex: The most rewarding part has been the Healthy Students, Promising Futures Learning Collaborative, which we launched to help states bring their state Medicaid plans into alignment with federal policy. We saw the need for funding and a lack of awareness about the opportunity. People were working in silos; bringing state and school district leaders together and providing them with the opportunity to learn from one another and to share successes and challenges emerged as an effective vehicle for driving conversations at the national level.

The most challenging part is having to do that case-making. You have these two systems – health and education – that aren’t used to working together. We still run up against the challenge of getting them to understand why investing in health services is worth it, and why they should be going through the headache of trying to bill Medicaid. It seems like such an easy case to make, and yet it isn’t.

Oddly enough, COVID-19 really helped. It shifted the conversation on the health side and made obvious the role that schools can play in supporting health and wellness. I also think educators are understanding how critical health and wellness are, and they want to draw on any and all resources. So I feel optimistic. We’ve been able to make tremendous progress, but breaking through those silos and getting two huge systems and sectors to talk to each other continues to be a challenge.

HSC: What opportunity do you see for other federal policies or initiatives to play a larger role in supporting student health?

Alex: We’re at the point where states have served as incubators in multiple ways – now it’s time for federal policy to support and formalize the best practices and lessons learned. For example, the Centers for Medicare and Medicaid Services last updated its school Medicaid guidance in 2003; we need federal guidance that writes best practices into regulation. We have a supportive administration and Congress, so there’s a real chance to get things done.

HSC: You’ve worked with a number of policy advocates. How have they inspired your work?

Alex: That’s another reason that the Learning Collaborative has been the most rewarding part of the job – the chance to meet so many people in school districts, state agencies and in other positions that understand the incredible importance of making these policy changes.

Eva Stone, manager of district health services for Jefferson County Public Schools in Kentucky, has been one of my absolute favorites. We used to do a school nurse leadership award, and she won that for her work on chronic absenteeism. Then she asked about the opportunity with school Medicaid, and she got things changed in Kentucky. It’s been a full circle experience – coming in as an intern and starting on the school nurse leadership program, working to train school nurses to be advocates, and then going to the Capitol and engaging with state decision-makers around these issues.

There are many fantastic state agency and school district people that we’ve had the chance to work with through the Learning Collaborative, along with national partners – the folks at the National Alliance for Medicaid and Education, American Federation of Teachers, Council for Chief State School Officers, American Academy of Pediatrics – and a whole host of others. There are not many people that have familiarity with school Medicaid, so it ends up being a collaborative space because no one person can get this done on their own.

HSC: When you look back on the last 12 years, what about HSC’s approach to healthy schools resonates with you the most?

Alex: While HSC has always looked for the bigger changes that enable communities and school districts to support health and wellness, so much of what we’ve done has been grounded in our program work in Chicago. Take school Medicaid, for example; we never would have gone down that path if we hadn’t been working with school nurses – recognizing the champions that they can be for health and wellness and understanding the issues they’re facing.

It’s the same around accountability and getting health and wellness included in education law. Much of that was based on what we’ve done to include health and wellness in Chicago Public School report cards and accountability systems.

HSC: What lessons did you learn from your work that you’ll bring to your next job?

Alex: There’s recognition that schools are a critical place to support children’s mental health and wellness, but historically that work has been difficult to fund. We run into that a lot with our work on school Medicaid; there’s so much that schools can do to prevent a kid from getting to the point of having the diagnosis, but healthcare dollars typically won’t fund that work.

California is rethinking how to leverage healthcare dollars and state funding for prevention and early intervention, and the state is rolling out a new program to support partnerships between managed care organizations and school districts. I’ll be working for Kaiser Permanente to support their work on this statewide initiative.

At its core, it’s building a partnership between these two huge entities, California public schools and the largest managed care organization in the state. Much of it will be figuring out the common languages between the different players. Also, being on the healthcare side, I’m helping the Kaiser team understand what’s happening in schools, including around Medicaid billing.

Healthy Schools Campaign has been like being in a Ph.D. program for 12 years – now I’m going to go and try to implement what we’ve talked about.