Alex Mays, Senior Policy Analyst, Healthy Schools Campaign
We know that student health issues are a leading cause of chronic absenteeism. So making sure that kids have access to school health services – physical, dental, and behavioral – is an important part of strategies to reduce chronic absenteeism. The US Centers for Medicare and Medicaid Services (CMS) recently took an important step towards increasing access to school health services for students. In a letter to State Medicaid Directors, CMS removed a major barrier to school-based health care services and clarified that the free care policy does not apply to schools.
Since 1997, the free care policy has made it difficult for schools to receive Medicaid funds to pay for services that are available, without charge, to everyone in the community. Since school health providers serve the entire school community, many of the services they provide to Medicaid beneficiaries were considered not eligible for reimbursement. As a result, school health providers are typically underfunded and many students across the country do not have access to regular school health services. For example, less than 50% of students have access to a full-time school nurse, according to research from the National Association of School Nurses.
Research supports a clear link between providing kids better access to school health services and a drop in chromic student attendance. Allowing students to receive health services at school is a proven strategy for addressing the health conditions that interfere with a child’s ability to learn. This is especially true for younger students in K through 3rd grade, where research shows that just two days missed per month, whether excused because of illness, or unexcused, leads to academic trouble for students as early as the 5th grade.
The reversal of the free care policy presents an opportunity for schools and districts to increase access to school health services for students. The change also can make it easier for districts to provide the medical care and attention that many students need to stay healthy, so they are able to attend school every day. Student illnesses, such as colds and earaches, to more long-term health challenges such as asthma, diabetes, vision impairment and mental health issues, are a leading cause of chronic absenteeism.
The free care policy has been the focus of dispute for a number of state agencies. In 2004, the U.S. Departments of Health and Human Services ruled that the free care policy, as applied to school districts, has no basis in federal Medicaid law, and is unenforceable when applied to schools. In keeping with this ruling CMS recently agreed to reimburse the San Francisco Unified School District for health services delivered to the general student population by school health professionals. Advocates such as Healthy Schools Campaign, Trust for America’s Health and the National Alliance for Medicaid in Education, have been working over the past decade to clarify that the free care policy does not apply to school-based health services.
There is still some work to be done. Before schools can apply for Medicaid reimbursement for health services, each state must decide to allow school districts to bill for additional health services delivered to students. In many states, this will require an amendment to the state Medicaid plan. Louisiana and South Carolina have already passed amendments to their state Medicaid plans to allow school districts to seek reimbursement for additional school health services, and California is not far behind.
One of the most important next steps in implementing this change will be supporting state-level efforts to implement the reversal of the free care policy. To better understand what the change in the free care policy means in your state, and how to leverage this opportunity to support student health services, and boost school attendance check out this stakeholder’s guide on the free care policy created by Healthy Schools Campaign.
We encourage you to spread the word about this recent change and the role that school-based health services can play in reducing chronic absenteeism in your community. We view it as a major important step forward in providing health care for students, especially for low-income students who may not have access to affordable health care. This revised policy also clearly supports the important connection between good health, learning, and student achievement.
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