Schools are essential places for children to access health services. An estimated 40 percent of school-aged children have at least one chronic health condition (National Survey of Children’s Health, 2019). Among low-income children with special health care needs, approximately 87 percent do not receive necessary care, primarily due to financial costs and limited access (Child and Adolescent Health Measurement Initiative, 2022). Providing health care at school, where children spend most of their days, is crucial to addressing these concerns, and Medicaid cuts put this at risk.

School health services encompass physical, behavioral, and mental health care that can be delivered by school health staff, such as school nurses, social workers and speech-language pathologists, as well as through school-based health centers and partnerships with local health organizations. Decades of research have shown that schools provide essential care that supports children’s short and long-term health and academic outcomes (Leroy et al., 2016).

Medicaid and School Health Funding

Medicaid plays a key role in funding school health services, spending more than $8 billion annually, according to an analysis of the most recent available data (Centers for Medicare and Medicaid Services, 2024).

Over the past decade, states and school districts have leveraged federal opportunities created with bipartisan support to increase Medicaid reimbursement (Mandle, 2024). This includes updating state Medicaid plans to 1) expand the types of Medicaid-covered school health services and providers eligible to bill Medicaid and 2) ensure schools can bill for all services provided to all Medicaid-enrolled students, not just the services included in a student’s Individualized Education Plan (IEP). This has led to a greater number of students receiving a broader range of care, including mental health services.

How Medicaid Cuts Will Impact Schools

The federal reconciliation bill signed into law in July 2025 (H.R.1) cuts almost $1 trillion in federal funding from Medicaid over the next decade. While H.R.1 does not place limits on the school Medicaid program, all states will face considerable decreases in the amount of federal Medicaid funding they receive, which is likely to cause significant budget gaps that will force states to draw from general funds, raise taxes, and/or cut Medicaid benefits. This puts the school Medicaid program at risk.

Read the full article about Medicaid cuts and school health services by Jessie Mandle at Grantmakers In Health.