How States Are Partnering With Schools to Advance Rural Health Programs
February 06, 2026 | Written By: Healthy Schools Campaign
Photo by Allison Shelley/The Verbatim Agency for EDUimages
From expanding Medicaid-funded school-based health centers to fostering collaboration with other health organizations, states recognize the vital role schools play in delivering care in rural areas.
The Centers for Medicare and Medicaid Services (CMS) recently announced $50 billion in state grants to strengthen and modernize healthcare in rural communities. The grants were awarded in varying amounts to all 50 states under the Rural Health Transformation (RHT) Program.
Schools play an essential role in meeting RHT goals and improving rural health outcomes. A number of states included school-related initiatives, such as establishing school-based health clinics funded in part by Medicaid, in their RHT project abstracts (see examples below). These proposals highlight ways schools can improve the health of children, families and communities.
To be clear, RHT grants cannot offset the roughly $1 trillion in federal Medicaid funding cuts under HR1, which will harm health services and access to care in rural communities. Healthy Schools Campaign will continue to monitor the impact and share resources to help states and school districts preserve student access to care through the school Medicaid program.
Using School Medicaid to Advance Rural Health
School Medicaid funding reimburses schools for providing medically necessary services to students enrolled in Medicaid. In recent years, more states – with bipartisan federal support – have allowed schools to bill Medicaid for an expanded range of services and provider types. This opened the door to additional, sustainable funding for services schools already provided without reimbursement.
When schools seek reimbursement for the full array of Medicaid-covered services and providers who work in schools, districts receive more money. These funds can be reinvested into school health programs to expand services and to retain and hire health providers.
Long travel distances and limited connectivity make it more difficult for families in rural areas to access healthcare, increasing communities’ reliance on schools to deliver health services, including primary care. School Medicaid can contribute to substantial health improvements in such areas as:
- Chronic disease prevention: School Medicaid can help schools pay for preventive and chronic disease management services. Providing healthcare at school, where children spend most of their days, is crucial to preventing and managing chronic conditions.
- Access to mental, behavioral health and substance use prevention and intervention services: In some states, school districts can seek Medicaid reimbursement for covered behavioral health and substance use services and providers, expanding the healthcare options available to students closer to home.
- Rural healthcare workforce and pipeline: School districts can reinvest Medicaid reimbursement funds into school health programs, making it easier to retain health providers and hire additional staff.
- Healthcare costs: School-based health providers and services, funded in part by Medicaid, help lower overall healthcare costs by providing preventive and early intervention care for all students. Schools are uniquely positioned to identify health conditions before they worsen and provide care to students who may otherwise have difficulty seeing a health provider, due to transportation challenges, scheduling or other access barriers.
How RHT Funds Can Be Used to Implement School Medicaid Billing
While school Medicaid programs can bring in more money for school districts, implementing a Medicaid reimbursement program can be administratively complex, especially in rural districts. States can use RHT funds for time-limited projects that will increase their ability to successfully receive Medicaid reimbursement. Here are some suggestions:
- Establish a consortium billing model where a lead school district or educational service agency manages the program administration for a group of smaller rural school districts
- Develop state guidance and support to help rural districts set up their program infrastructure
- Train rural navigators or telefacilitators who are available to help school districts embed Medicaid billing into their workflow and systems
- Identify capacity-building or training technologies to support innovation in rural schools
State Examples of RHT Projects Involving Schools
Schools are vital to achieving successful health outcomes in RHT programs. Healthy Schools Campaign identified how some states are involving school health programs in their project plans, based on grant abstracts and state spotlights compiled by CMS.
| State | Rural Health Project Plans |
|---|---|
| Arkansas | Improve access and outcomes by expanding hospital, primary, specialty and behavioral care, including expansion of maternal health, school-based centers and community wellness programs. |
| Connecticut | Develop 23-hour crisis-stabilization centers linked to rural hospitals, coupled with real-time psychiatric expertise across clinics, emergency departments, schools and mobile crisis teams. Strengthen recruitment, training and retention of healthcare providers and staff through education partnerships, telehealth support and career pipelines. |
| Colorado | Bring together physical, behavioral, public health, schools and local businesses to partner to improve outcomes and affordability. Recruit and keep local providers, including but not limited to physicians, nurses, paramedics, local education partnerships and behavioral health professionals, through streamlined credentialing processes, cross-training and assessing and supporting workforce needs. |
| Delaware | Deploy mobile health units, create school-based health centers and expand library-based health services to eliminate transportation barriers and bring care directly to rural communities. |
| Florida | Address food insecurity, nutrition counseling and school-based wellness programs to reduce chronic disease. |
| Iowa | Develop enhanced Health Hubs, or hub-and-spoke networks of care, with investments in telehealth, specialized medical equipment, provider recruitment and retention and efficient space utilization; hubs may include school-based service provision. |
| Maine | Establish alternative sites of care, such as CCBHCs and school-based health centers, that offer mental health and dental care in addition to preventative health services. |
| Maryland | Promote sustainable access and innovative care through new and expanded capacity for primary care, specialty practices, school-based health centers and behavioral health expansion. |
| Mississippi | Foster collaboration among rural hospitals, FQHCs, clinics, community organizations and educational institutions to create sustainable, data-driven improvements in health outcomes. |
| New Hampshire | Invest in local infrastructure for disease prevention by establishing community access points beyond traditional clinical care, such as through schools, libraries and mobile clinics. |
| New York | Build out preventive care in primary and specialty services through patient-centered medical homes, partnership networks and school-based programs. |
| Ohio | Establish school-based health centers on K–12 and college campuses to provide primary prevention and sick care, screenings and exams, dental care, behavioral health and telehealth services for students and community members, serving also as rural clinical training sites. Expand statewide mobile vision, hearing and dental care for elementary school children to ensure early diagnosis and treatment. |
| Rhode Island | Use community-integrated and mobile health services to bring preventive, dental and maternal-child healthcare directly to residents through mobile units and telehealth sites in schools and community learning centers. |
For more information, visit KFF Health News, which features each state’s full RHT program application.
