When School Buildings Close: What Districts Need to Provide Student Health Services

March 12, 2021

Photo: Allison Shelley for American Education: Images of Teachers and Students in Action

A new HSC policy brief identifies the challenges schools have encountered in providing school-based health services during the COVID-19 pandemic and recommends changes to state and federal policy to expand healthcare access before the next public health crisis.



By Alex Mays, Senior National Program Director

Almost exactly one year ago, concerns over the spread of the novel coronavirus caused most states to start closing school buildings, sending students home for what was thought to be a couple of weeks, maybe a month, of remote learning. Instead, more than half of all public schools kept their doors closed through the remainder of the 2020 academic year. 

Today, the COVID-19 pandemic continues to cause uneven disruptions across the country. In most states, a majority of students can now attend classes in-person, either full-time or hybrid. Some students haven’t stepped inside a school building in a year.

While there has been much study about efforts to keep students engaged academically, less attention has been paid to the importance of maintaining healthcare access — even though millions of children, especially in low-income communities, 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. Access to school-based health services is as important as access to school food.

Healthy Schools Campaign today is releasing a new policy brief, “Providing Health Services During School Closures: Lessons Learned & Recommendations for Action” (view pdf). The brief provides an acute analysis of the challenges schools have encountered while providing physical, behavioral and mental health services during the COVID-19 pandemic.

Federal & State Responses

As early as March 2020, state and federal agencies moved to ensure school-based health providers could deliver services remotely, and that payment systems, including Medicaid, were in place for reimbursement. Administrative, technological and regulatory barriers were promptly identified and addressed on a state-by-state basis.

Our analysis of the effectiveness of these changes draws upon our work with states through HSC’s Healthy Students, Promising Futures Learning Collaborative. Many of the policy changes implemented, especially around telemedicine and parental consent, helped ensure quicker responses and minimized gaps in access to school-based healthcare. 

Though school districts did their best, the results were inconsistent and incomplete. By fall, states faced a series of new challenges, including contact tracing and missed well-child visits and vaccinations, as schools moved to return to in-person learning.  

Additional Action is Needed

Much more needs to be done to support schools in these efforts. “Providing Health Services During School Closures” offers extensive policy recommendations that state and federal agencies can implement now, to offer assistance during the current pandemic, and in preparation for building closures due to future public health emergencies and natural disasters.  

We also call attention to the current patchwork delivery structure causing healthcare access disparities both among and within states. Some school districts have resources but are restrained by rules. Other districts lack funds and guidance to address the increased needs of students who have spent a year learning from home. Many are unable to ensure that students who are medically frail can safely return when their school buildings reopen. 

We believe that the strategies we have identified and the recommendations that follow can improve healthcare access and outcomes. Yet we also acknowledge that neither is achievable unless state and federal policymakers treat this as a public health emergency. 

Immediate action is needed to address funding and regulatory barriers that make it difficult, if not impossible, for schools to meet student health needs, regardless of whether they are attending school in-person or remotely. And in those places where the flexibility already exists, our recommendations lean on policymakers to make the choice to accelerate best practices. 

States and school districts are managing the best they can with the resources they have. The least we can do, especially as schools face a new set of pressures as they reopen their doors, is ensure public policy is not an impediment to public health.

Learn more: View the HSC webinar on providing health services during school closures.