Structural Inefficiencies in the School-Based Medicaid Program Disadvantage Small and Rural Districts and Students

When children come to school with unmet health needs, they struggle to learn. However, ensuring that all children attend school ready-to-learn and have access to the school and community services necessary to meet their comprehensive health needs is a serious challenge for school leaders and a community imperative.

It is easy to point to inadequate funding as a barrier to providing children with the health-related services that they need to learn and which are mandated by law. It is easy, because it is true.

Accordingly, over the past 25 years, school districts have looked to Medicaid, the same program that provides health care to millions of eligible children and families, to help mitigate the effects of constrained financial resources while facing ever-escalating demands for health services in our schools.

The Medicaid program provides districts with a reimbursement stream that enables eligible children with healthcare services they may not be able to access anywhere else.

Educating children and ensuring they have the supports they need in order to learn is the main focus of school districts—not managing health care billing systems—and the challenges of balancing both are intensifying. 

Participating in the Medicaid program is not easy for school districts and there are many obstacles to obtaining Medicaid reimbursement.

Educating children and ensuring they have the supports they need in order to learn is the main focus of school districts—not managing health care billing systems—and the challenges of balancing both are intensifying. For the first time in nearly a decade, the number of uninsured children in the United States increased in 2018 and one out of every five children experiences a major mental or behavioral health disorder.

Awareness that educational equity and health care equity are intrinsically linked is becoming more commonplace, but because a significant share of states are providing much less school funding than they were a decade ago, there are fewer local education dollars allocated to addressing the health care issues of children in school.

What does this mean for school leaders? We know our primary responsibility is to make sure children are learning and growing into productive, healthy citizens, but this goal is becoming progressively more difficult as children come to school with increasingly unmet health needs.

How can we achieve this objective if a child is suffering from frequent asthma attacks or hypoglycemia at school and at home and lacks access to appropriate treatment? What if a child is unable to see the chalkboard well or hear their teacher in class and the parent cannot take them for a hearing or vision screening?

The time has come to improve upon the services we deliver to children in schools.

We must ensure school-based Medicaid can be an effective and sustained program for children, and that districts are provided the necessary resources to meet the growing physical and mental health care needs of children.