Schools are places where health care happens, an essential part of the nation’s public health infrastructure. During COVID-19, schools across the country responded to the call to action to vaccinate students and community members and to provide nutritious meals and mental health counseling services to kids — despite shuttered classrooms. Even before the pandemic, schools were providing care that supports classroom learning to the 14% of public school children who have special health care needs, including those with chronic physical, developmental, behavioral or emotional conditions.

A recent study in JAMA Pediatrics found that schools are “the de facto mental health system,” providing services to 57% of adolescents who needed care before the pandemic. In 2019, the Centers for Disease Control and Prevention found 37% of high school students reported persistent feelings of sadness or hopelessness; 19% having seriously considered suicide; and 9% having attempted suicide. And the need is even more profound now. From April to October 2021, the proportion of pediatric emergency room visits that were mental health-related increased nearly a third for ages 12 to 17 and 24% for children aged 5 to 11.

As is always the challenge in public education, the need far outweighs the resources available. But changes in federal Medicaid payment policy have paved the way for schools to access millions of dollars to fund school nursing, behavioral health and other services in schools.

For example, in 2014, the Centers for Medicare and Medicaid Services broadened a longstanding policy to allow schools to be reimbursed for providing covered services to any Medicaid-eligible child. But only 17 states have taken advantage of this funding stream by amending their Medicaid state plans (the document that defines the types of services and providers that are eligible for reimbursement) to reflect the new policy.

Michigan altered its state plan to include behavioral health analysts, school social workers and school psychologists as covered providers, while the state legislature approved $31 million to fund behavioral health providers in schools. Since this change, there has been about a 6% increase in the amount of Medicaid reimbursement being directed to schools. Louisiana amended its Medicaid state plan in 2015 and saw a 30% increase in its Medicaid revenue as the school nursing workforce grew 15%. Last year, Georgia changed its plan to allow Medicaid to pay for more school health services. Half of Georgia’s kids are covered by Medicaid or the state’s PeachCare system, so this shift is dramatic and creates an opportunity to bring hundreds of millions of dollars to Georgia’s school districts to support the most vulnerable students.

Read the full article about healthcare for students by Donna Mazyck at The 74.