What Makes a Healthy School When Schools Are Closed and Learning is Remote?

March 10, 2021

What makes a healthy school? 

It’s a deceptively complex question, one that HSC works to articulate daily through vision and practice. 

Since COVID, we’ve spent the better part of a year asking a slightly modified version: What makes a healthy school when schools are closed and learning is remote? 

During a recent roundtable discussion on WSCC Policies in Support of Equity in Education, Alex Mays, HSC’s senior national policy director, underscored the importance of continuous delivery of school health services — especially when children are learning at home. 

Mays pointed to recent federal and state policy changes that encourage the expansion of telehealth services allowing school health providers — including school nurses, psychologists, social workers, speech-language pathologists and occupational therapists — to connect with students remotely, and to bill Medicaid for these services. 
These policy shifts are especially important as children have experienced increased mental health issues due to isolation and trauma.   

The discussion, organized by the American School Health Association, brought together several policy experts who contributed to a special edition of the Journal of School Health (December 2020). Published under the theme Every School Healthy, the full issue, featuring 14 articles, is available free of charge thanks to support from the Robert Wood Johnson Foundation.

Mays’ article, “Advancing Student Health and Achievement Through Medicaid: Lessons Learned from State Efforts to Expand Medicaid‐Funded School Health Services,” addresses the federal opportunity, implemented at the end of 2014, allowing school districts to seek reimbursement for all health services delivered to all students enrolled in Medicaid. 

The original policy was understood to prevent such reimbursement, except in the case of health services mandated in a student’s IEP.  Mays writes:

The policy change allows school districts to expand their school-based Medicaid programs to cover more students and bring in additional, sustainable federal funding. It can also improve health equity by supporting increased reimbursement for school districts that serve higher percentages of Medicaid-enrolled students.

Finally, it presents an important opportunity to support implementation of multiple Whole School, Whole Community, Whole Child (WSCC) components including health services, counseling, psychological and social services, employee wellness, and social and emotional school climate.

However, CMS presented an opportunity, not a mandate. There is a critical need to support states in implementing the policy change and ensure this opportunity is leveraged to expand access to and resources for school health services for children across the country.

To date, 13 states have updated their state Medicaid plans to align with federal policy, making it possible for them to successfully expand their school-based Medicaid programs and add new Medicaid-eligible providers and services. Here’s a look at how those states, and their students, are benefitting

We are assisting other states working toward CMS approval, many of which are eager to do so to address unmet mental health needs, and we expect Illinois to take the necessary steps this year.

HSC strongly believes in the importance of this policy as a sustainable mechanism for school health funding. It is also essential for health equity, both when schools are open and especially when school buildings are closed. 

Visit the December 2020 Journal of School Health for more articles on healthy schools and equity.