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.
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:
- Find out more about the Healthy Students, Promising Futures national learning collaborative, or download our Stakeholder’s Guide to Implementing the Change in the Free Care Policy.
- Check out our Resources tab
- Connect with us on Facebook and follow us on Twitter and Instagram (@healthyschools)
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.
Stakeholder’s Guide to Implementing the Change in the Free Care Policy
This framework highlights key steps advocates 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.
Schools Are Key to Improving Children’s Health
Key opportunities exist for education, healthcare and public health sectors to improve both health and education outcomes by focusing on school-based health services. This brief addresses the opportunities to expand on health services delivered within a school by school nurses and other district-employed providers.