Schools Are Essential to Improving Health Outcomes
The education system provides healthcare for millions of children across the country, particularly children of color in low-income communities. The COVID-19 pandemic and school closures have revealed in a new way the importance of critical school health services. Numerous studies show that access to school health services improves health and academic outcomes, such as reduced emergency room utilization and chronic absenteeism, particularly for children with chronic health problems.
1 in 4 children has a chronic health issue
One in four U.S. children has a chronic physical or mental health issue that affects their ability to succeed in the classroom—double the national rate from 30 years ago. Rates are even higher for students in underserved communities, particularly students of color. This undermines efforts to close the opportunity gap.
Health professionals increasingly have recognized schools as the ideal setting to achieve many of healthcare provider’s fundamental objectives: early prevention, disease management, reducing per-capita healthcare costs, reducing emergency room usage and improving overall quality of care. Schools also offer an invaluable opportunity to provide primary healthcare treatment to vulnerable and underserved populations.
These factors have made schools the front-line in improving children’s health outcomes. Yet more than half of public schools do not have a full-time school nurse or school counselor, and less than 5 percent of U.S. students have access to services through a school-based health center.
But we can fix that. There are opportunities for schools districts, states, health and education officials and the federal government to increase access to school health services.
For example, a 2014 federal policy change vastly expanded the number of school-based health services that can be reimbursed by Medicaid—but only if states act to make use of it. In addition, local partnerships between health and education systems have been shown to improve care delivery, programmatic evaluations, resulting in better student health outcomes. Healthy Schools Campaign is a national leader in supporting states and school districts in leveraging both of these opportunities.
There are more than 50 million children attending elementary and secondary schools across the United States. Using schools as a resource to provide them with access to healthcare has the potential to help those kids become healthy and productive adults.
The Opportunity to Expand School Health Services
Healthcare happens in many ways in schools. School-based health services include physical, behavioral and mental healthcare that can be delivered by a range of providers, including school nurses, psychologists, and speech-language pathologists, as well as school-based health
centers or through partnerships with local health organizations.
While there are many ways to support school health services, where we see the most potential right now is taking advantage of the opportunity created by the federal Medicaid policy change and fostering partnerships between the health and education sectors.
The 2014 change to federal healthcare policy vastly expanded the number of school-based health services that can be reimbursed by Medicaid. The new rule empowered states to allow schools to bill for all Medicaid-eligible services for all Medicaid-enrolled students, creating a substantial funding stream for providing primary healthcare in schools, especially to underserved populations. In many cases, this means funding for health services that schools are already providing.
As of June 2020, 13 states have successfully expanded their school-based Medicaid programs (five of them since August 2019 alone), with more states working to do so. Many states are also using this opportunity to get Medicaid to recognize the role of additional providers who are delivering services in schools—and to increase the types of school-based physical and behavioral health services that are reimbursed by Medicaid.
However, the majority of states have not embraced the rule change. This leaves hundreds of millions of federal dollars unclaimed, depriving children of vital health services, and straining state taxpayers and state education budgets. Many state Medicaid plans remain aligned with the previous federal policy, which means schools are only able to seek Medicaid reimbursement for specific health services. Other states formalized the old Medicaid policy into state law, constricting reimbursements. States must amend their state Medicaid plan and/or state statute and then update their state’s school Medicaid guidance.
Meanwhile, at the local level, partnerships between school districts and health providers have forged another path to expanding school-based health services. Health providers have created school-based health centers that act as comprehensive primary care clinics offering medical, dental and mental health services, as well as immunizations and screenings. Partnerships have allowed local health providers to initiate school-based programs to address diabetes, obesity, asthma and mental health issues. Pilot program data exchanges between schools and health providers have created new opportunities to evaluate outcomes of school-based health interventions, such as asthma prevention programs.
Supporting Schools + States and Fostering Collaboration
Healthy Schools Campaign works closely with state policymakers, education officials and educators to help expand health services in school settings.
Expanding Medicaid Capacity
Healthy Schools Campaign provides critical support to states as they work to understand the federal Medicaid policy change; amend their state policies and programs; and evaluate the impact. HSC has created targeted policy recommendations and guides to support everyone working to expand access to school health services, including state and local education agency staff, state Medicaid agencies, school health providers, public health professionals, and advocates.
HSC works to:
- Help policymakers understand how existing laws in their state might limit Medicaid reimbursement for school health, develop strategies to expand school-based Medicaid programs, and implement trainings to leverage the new funding
- Manage the Healthy Students, Promising Futures learning collaborative that brings together state teams committed to increasing access to Medicaid services in schools and promoting safe and supportive school environments
- Advise state departments of public health and state education agencies on how to assess the leading health issues impacting students in the state to ensure the health services needed to address those issues are Medicaid reimbursable
- Recommend ways that federal agencies can offer support, technical assistance and replicable models to states and school districts in expanding Medicaid programs
- Direct stakeholders how to identify the key health and education decision-makers and build support at the state and local levels
Fostering Cross-sector Partnerships
Healthy Schools Campaign works closely with education, healthcare and public health partners to build and sustain collaborative cross-sector endeavors aimed at improving student health.
HSC does this by:
- Advising local and regional medical providers on how to partner with schools to create coordinated approaches to improving student health
- Fostering cooperation between state health departments and state educational agencies to develop better school-based health strategies and data sharing
- Leveraging partnerships in efforts to persuade state officials to open additional funding streams for school health
- Convening the Chicago School Health Access Collaborative in partnership with the Public Health Institute of Metropolitan Chicago to bring together health providers and payers, Chicago public schools officials, and advocacy organizations to help coordinate care, alleviate barriers to cooperation, facilitate data sharing, and share best practices
What You Can Do
Your voice matters in urging national, state and school leaders to prioritize the link between learning and health and increase access to school health services. We invite you to learn more and lend your voice to the dialogue about school health services:
- Find out more about the Healthy Students, Promising Futures national learning collaborative
- Download our Schools Are Key to Improving Children’s Health brief, which offers an easy-to-understand but comprehensive look at the opportunity to expand school health services.
- Connect with us on Facebook and follow us on Twitter and Instagram (@healthyschools)
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.
Key Health Services Resources
Expanding school-based health services can improve both health and education outcomes. The following policy briefs explain how to increase access to these services using available federal funds. Visit the main Resource Center for additional materials for states, school districts and health professionals.
Schools Are Key to Improving Children’s Health
This national policy brief addresses the opportunities to expand on health services delivered within a school by school nurses and other district-employed providers.
How Illinois Can Leverage Medicaid Funds to Expand School Health Services
Building off Schools Are Key to Improving Children’s Health, this brief looks at the state of children’s health and school staffing in Illinois and outlines the steps Illinois must take to amend its Medicaid state plan and increase access to health services.
A Guide to Expanding Medicaid-Funded School Health Services
This comprehensive, step-by-step guide provides background on school-based Medicaid and outlines various opportunities to advance state policy changes required to access federal funds.
Medicaid 101 for School Superintendents
This brief explores what Medicaid is, what it covers—in and out of school—and how school districts can leverage Medicaid to enhance school health services.