Health Services

Increasing access to school health services presents an important opportunity to reach vulnerable and underserved children and support children’s health and achievement.

School Health Services Matter More than Ever

Today, one in four American children have health issues that affect their ability to succeed in the classroom, double the number just 30 years ago. This has implications not only for children’s long-term health but also for their opportunities to learn and succeed at school. Student health problems are one of the leading causes of absenteeism and, as a result, can have a significant impact on academic achievement. For example, children with oral health problems and children with asthma are over three times more likely to miss school than their peers.

In addition, low-income students of color are at increased risk of health problems that hinder learning. Research suggests that unless we address these health disparities, efforts to close the academic achievement gap will be compromised.

School-based health services are essential to addressing these issues. These can include a wide variety of physical, behavioral and mental health services delivered by school nurses, at school-based health centers or through partnerships with local health organizations. Multiple studies show that school nurses reduce absenteeism and a higher nurse to student ratio is related to better attendance. According to the American Public Health Association, school-based health center use is associated with gains in grade point average (GPA) and attendance; students without access to a school-based health center lose three times as much in-class time as students enrolled in a center.

HSC works with partners to advocate for policies and practices at the federal, state and district level that enable students to received the physical and mental health care that they need. Learn more about our work on health services by clicking the tabs at the top of this page.

 

New Opportunities to Expand School-Based Health Services

Despite the clear connection between school health services and student success, more than half of public schools currently do not have a full-time school nurse or school counselor and only 5 percent of the nation’s students have access to a school-based health center. Significant disparities exist in access to school health services. Students in low-income schools are less likely to have regular access to a school nurse compared to their peers in higher-income schools.

Over the last few years, several policy and practice changes have taken place that provide new opportunities to expand students’ access to the physical and mental health care they need. Along with these opportunities come challenges, and HSC is working hard to find new and innovative solutions.


Medicaid Policy

For nearly 20 years, under a longstanding Medicaid guidance known as the free care policy, school districts could only bill Medicaid for health services included in a student’s Individualized Education Program (IEP) and services provided through the Title V Maternal and Child Health Services Block Grant. In December 2014, this guidance was reversed, allowing school districts to receive reimbursement from Medicaid for any eligible service delivered by an eligible provider to a student enrolled in Medicaid. These services can include, but are not limited to: behavioral and mental health care; Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services; physician services; optometry services; dental services; and nutritional services. For districts serving low-income students, this gives Medicaid the potential to be a major funding source for school-based health services. Find out how HSC is helping states leverage Medicaid to expand school health services in the What We’re Doing tab.


New Priorities for Health Care Systems

As the health sector increasingly prioritizes prevention, population health, care coordination and chronic disease management, health providers are realizing that school health services are a way for them to engage with otherwise hard-to-reach populations. School health services can also help them meet many of the new metrics they are being held accountable for under the Affordable Care Act. For instance, school health services can reduce children’s emergency room usage, facilitate enrollment in Medicaid and the Children’s Health Insurance Program, increase immunization rates and lead to an overall healthier school population. Find out how HSC is helping bring health providers and schools together in the What We’re Doing tab.


The Every Student Succeeds Act

The new federal education law, the Every Student Succeeds Act (ESSA) provides new opportunities for states and school districts to focus on student health and wellness, In particular, many states now measure chronic absenteeism rates as part of their school accountability system. Find out more about how HSC is helping states and school districts build education plans that support student health and wellness on our Education Policy page.

Helping Transform School-Based Health Services Across the Country

HSC and Trust for America’s Health co-convene the Healthy Students, Promising Futures national learning collaborative, a group that brings together state teams committed to increasing access to school health services through Medicaid reimbursement. This group was launched in 2016 by the U.S. Department of Education, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services and is now led by HSC and Trust for America’s Health.

Participating state teams receive ongoing technical assistance throughout the year from national partner organizations and content experts on topics such as federal and state policies that impact school-based health services, data sharing agreements, different models for delivering school-based health services, ways to work with non-profit partners and best practices from other states experiencing similar challenges.


Helping Chicago Build School-Based Health Services

HSC and the Public Health Institute of Metropolitan Chicago co-convene the School Health Access Collaborative (SHAC), a group of over 30 Chicago health and education stakeholders working to improve the school health services infrastructure in order to provide comprehensive, coordinated, and sustainable care for Chicago students. This group is working to address key priorities such as data sharing and identifying innovative service delivery models.


Helping Build the Connection Between Learning and Health

HSC is launching a new national Coalition for Learning + Health that will bring together health, education and civil rights organizations to develop and advance a broad and inclusive agenda that links education and health so all students can learn and thrive. This coalition will build on and expand the important work of the National Collaborative on Education and Health.

What You Can Do

Your voice matters in urging national, state and school leaders to prioritize the link between learning and health. We invite you to learn more and lend your voice to the dialogue about this issue:


Make a Donation

As a nonprofit organization, we rely on support from people like you so we can continue to make schools healthier places where all children can learn and thrive. Your gift—large or small—will make a meaningful difference.

Health Services Resources

Access related resources below, or go to our main Resource Center to access resources across all of our program and policy areas.

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Addressing Mental Health and Wellness through ESSA Implementation

Untreated and undertreated mental health conditions remain a substantial factor in stifling academic achievement. Under ESSA, education leaders have the opportunity to remedy some of these underlying issues to ensure that schools integrate more evidence-based mental health promotion and treatment in the everyday workings of the education system, and help their students thrive and succeed.

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Addressing Nutrition and Physical Activity through ESSA Implementation

The Every Student Succeeds Act (ESSA) recognizes the need for schools to support the whole child and specifically acknowledges the importance of health and wellness. ESSA also provides an opportunity to ensure equitable access to quality education and the conditions that support student learning. Health is a key part of this. ESSA transitions authority from the federal government to state education agencies. Thus, as states begin to implement ESSA, it is critical they do so in a way that supports health and wellness.

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About the Healthy Students, Promising Futures Learning Collaborative

The Healthy Students, Promising Futures Learning Collaborative, in partnership with Healthy Schools Campaign and Trust for America’s Health, was launched in July 2016 to support states in expanding Medicaid services in schools, including physical and behavioral health services.

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“Free Care” Medicaid School Based Services

From the National Association for Medicaid in Education.

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Dismantling Barriers to School Health

From the American Federation of Teachers.

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Advocates’ Guide to the Change in the Medicaid Free Care Rule

This document provides guidance for health care advocates to engage a diverse set of partners to advance implementation of the medicaid free care rule change.

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Medicaid’s “Free Care Policy:” Results from Review of State Medicaid Plans

From the National Health Law Program.

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Policy Considerations for California Following the Reversal of the Medicaid “Free Care Rule”

From the California School-based Health Alliance.

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Let’s Take Medicaid Back to School

This blog offers concrete examples of how advocates and stakeholders can support school-based Medicaid programs, streamlining federal and state reimbursements to school districts and contributing to children's equitable, easy access to high-quality healthcare services.

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Medicaid Helps Schools Help Children

A clear overview of the role Medicaid plays in ensuring student health.

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State Resources on Medicaid and CHIP

From Georgetown Center for Children and Families.

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Happy, Healthy and Ready to Learn: Insure All Children

This toolkit focuses on school-based child health outreach and enrollment.

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Guide to School-Based Outreach for Health Coverage Enrollment

From the Center on Budget and Policy Priorities.

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A Guide for Incorporating Health and Wellness into School Improvement Plans

This guide explores the opportunities provided by School Improvement Plans to address the needs of the whole child, incorporating physical, social, emotional and/or behavioral health priorities into schools.

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State Health Department Leadership in Addressing Chronic Health Conditions in Schools: Case Studies from Massachusetts and Missouri

These case studies demonstrate the important role that state health departments can play in strengthening the management of chronic health conditions in schools, even in an era of limited funding.

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Ten Principles for Collaboration between the Health and Education Systems

From Healthy Schools Campaign and Trust for America's Health.

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Hospitals and Schools as Hubs for Building Healthy Communities

From Brookings Institution.

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Healthy Students, Promising Futures Tool Kit

This toolkit focuses on state and local action steps and practices to improve school-based health. It is structured around five key high-impact opportunities.

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How States are Leveraging Medicaid to Expand Health Services in Schools

Leveraging Medicaid to Expand Access to Health Services in Schools: An Update from the Healthy Students, Promising Futures State Learning Collaborative. The Healthy Students, Promising Futures Learning Collaborative includes a growing number of state teams from Departments of Education and Medicaid who are exploring ways to expand health services in schools and leverage funding through Medicaid. The Collaborative is supported by the U.S. Department of Education, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services, in partnership with Healthy Schools Campaign (HSC) and Trust for America’s Health (TFAH). This webinar provides an overview of the Collaborative and highlight preliminary findings, successes and challenges that the state teams are facing.

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Medicaid Managed Care 101: Building a Common Understanding for the Healthy Student

Managed care is the predominant delivery system for children’s health coverage in Medicaid. What is more, managed care plans are important partners when designing innovative care delivery models. This webinar provides basic background about Medicaid managed care and how managed care plans support children’s health through Medicaid. In addition, the webinar provides general guidelines about what plans may cover and how the benefit design may vary from state-to-state. Because every state’s experience with managed care is different, this is not be a deep dive into individual state policies, but it does answer general questions about the critical role managed care plans play—and includes a thoughtful discussion about how schools could work with managed care organizations.

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Behavioral Health 101: Exploring Best Practices for Behavioral Health in Schools

This webinar provides an overview of the components of a comprehensive school behavioral health system and highlights two examples from Colorado and California where schools or school districts are implementing innovative models to provide behavioral health promotion, prevention and treatment services in schools using a multi-tier system of supports (MTSS) utilizing federal and state funds.

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50 State Scan of Telehealth Reimbursement Laws and Medicaid Policies – Factsheet, Interactive Map

An overview of current national trends in Telehealth.

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How States are Leveraging Medicaid to Expand Health Services in Schools

The Healthy Students, Promising Futures Learning Collaborative includes a growing number of state teams from Departments of Education and Medicaid who are exploring ways to expand health services in schools and leverage funding through Medicaid. The Collaborative is supported by the U.S. Department of Education, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services, in partnership with Healthy Schools Campaign (HSC) and Trust for America’s Health (TFAH). This webinar provides an overview of the Collaborative and highlight preliminary findings, successes and challenges that the state teams are facing.

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Medicaid’s “Free Care Policy:” Results from Review of State Medicaid Plans

This issue brief reports findings from the National Health Law Program’s review of state Medicaid plans (SMPs) for provisions that may impact states’ ability to implement the federal government’s recent reversal of the “free care policy.” Specifically, we reviewed SMPs for provisions related to Medicaid reimbursement for services provided in schools that are available free of charge to beneficiaries and others in the community. This includes SMP provisions that directly prohibit coverage of such services as well as those that might indirectly prevent coverage.

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Healthy and Ready to Learn: Recommendations to the Next Administration

We can create a better future for our children and our nation by improving health in schools. The next President of the United States has the opportunity to support states, school districts and communities in creating the conditions of student health and wellness and giving all children a chance for a healthy, brighter tomorrow. This document outlines Healthy Schools Campaign’s recommendations to the next President for improving health and education for our nation's students.

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CDC Professional Development E-Learning & Resources

CDC Healthy Schools is releasing four professional development resources! CDC Training Tools for Healthy Schools (TTHS) is a comprehensive set of professional development resources to help educators, school health professionals and administrators create school environments where students are healthy and ready to learn. Online modules offer a tailored learning experience through 1-1.5 hour (free CEUs!) courses on School Health Guidelines to Promote Healthy Eating and Physical Activity; School Health Index: A Self-Assessment and Planning Guide; Comprehensive School Physical Activity Program: A Guide for Schools.

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COLORADO SCHOOL ASTHMA CARE PLAN

An example of Colorado's school asthma care plan that was presented during our Jan. 27 School Nurse Leadership: Tackling Absenteeism webinar.

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School Nurse Leadership Webinar: Tackling Absenteeism

The first of two important webinars focused on School Nurses celebrated two award-winning school nurses and kicked off our 2016 School Nurse Leadership Award. Kelly Graham is a school nurse from Colorado implementing data informed health interventions. An analysis of student data helped her identify students with asthma, implement effective interventions and assist these students in improving school attendance. Eva Stone hails from Kentucky and has also used student data to pinpoint the health reasons students were chronically missing school. In just one school year, all 10 schools in her district saw a decrease in the rate of chronically absent students. Both of these leaders demonstrate the power of school nurses and the importance of using data to improve student health. We’re excited to feature these two leaders and for them to share their strategies for tackling this very important topic.

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Free Care Policy Fact Sheet

The December 2014 reversal of the free care policy has the potential to increase access to and resources for school health services across the country. While this policy reversal was an important step towards addressing a long-standing barrier to schools seeking reimbursement for school health services, states and school districts must now implement this change.

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Stakeholder’s Guide to Implementing the Change in the Free Care Policy

The change in the free care policy presents an important opportunity to increase access to and resources for school health services. While the December 2014 State Medicaid Director letter clarified that school health services delivered to the general student population, not just those included in student Individualized Education Programs (IEPs), are eligible for Medicaid reimbursement, action is required from states and school districts to implement this change. The following framework highlights key steps you can take to develop and implement a plan for leveraging the change in the free care policy to support increased access to comprehensive and coordinated school health services.

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National Collaborative on Education and Health Metrics Working Group Report

Metrics Working Group of the National Collaborative on Education and Health Report to the National Steering Committee December 2014

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National Collaborative on Education and Health Health Systems Working Group Report

Health Systems Working Group of the National Collaborative on Education and Health Report to the National Steering Committee December 2014

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National Collaborative on Education and Health Chronic Absenteeism Working Group Report

Draft Report on the Chronic Absenteeism Working Group of the National Collaborative on Education and Health October 2015

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National Collaborative on Education and Health Working Group on Substance Misuse Report

Principles for Increasing Substance Misuse Prevention and Early Intervention in Schools

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Free Care Policy Convening: Meeting Summary

The following document summarizes the Free Care Policy Convening which was co-hosted by Trust for America’s Health and Healthy Schools Campaign, with support from the W.K. Kellogg Foundation.

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CDC’s Healthy Schools Website

A resource for data, multimedia, tools, training and resources from the CDC.

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National Prevention Strategy: America’s Plan for Better Health and Wellness

The nation’s first ever National Prevention and Health Promotion Strategy (National Prevention Strategy). This strategy is a critical component of the Affordable Care Act, and it provides an opportunity for us to become a more healthy and fit nation.

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