Ohio policy group touts benefits of school-based health care
An Ohio-based health policy group says students, particularly those enrolled in Medicaid, would benefit from more school-based health care options.
The Health Policy Institute of Ohio said the key to better outcomes for the state as a whole comes from healthy students who are able to attend school.
“Offering health care services to kids in schools, known as school-based health care, is a worthy investment, with the potential to improve future health and education outcomes for Ohio students,” the HPIO stated in a recently released paper on the issue.
The institute acknowledged the attention policymakers and school districts are increasingly giving to the connection between health and academic performance, but said financial stability and administrative burdens bring challenges in implementation.
A change on the federal level back in 2014, however, could present opportunities for the state to “leverage Medicaid reimbursement to improve the health and well-being of students.” The change allowed flexibility for coverage of school-based health services for Medicaid-enrolled students.
The state’s K-12 public school students include more than 700,000 students who were enrolled in Medicaid for at least three months, accounting for 42 percent of K-12 students, according to Ohio Department of Education and Workforce data for the 2022-2023 school year.
In that same school year, the HPIO found nearly 4 in 10 children enrolled in Medicaid were considered chronically absent, that is, missing more than 10 percent of instruction time in a school year. The rate for Medicaid-enrolled students was double that of students not enrolled in the program.
“Children from families with low incomes, and therefore eligible for Medicaid, often experience more barriers to accessing health care due to factors such as lack of transportation or parent challenges taking time off work,” the HPIO study stated. “These barriers increase the value of school-based health services for families.”
While school districts across the state have school nurses, psychologists, social workers, and counselors, many do not have the number that school-based provider associations would recommend, according to the HPIO. The study also found that services provided by these school-based professionals aren’t fully reimbursable with public or private insurance.
The Individuals with Disabilities Education Act (IDEA) already requires that students with special health needs get “free appropriate public education” and related services that align with the need of the student. Medical services that are needed are documented in individualized education plans (IEPs), plans which 17 percent of all students in Ohio had in the 2023-2024 academic year, HPIO research stated. Funding for the IDEA requirements is funded through a combination of federal, state and school district monies.
The 2014 federal change that HPIO says could present an opportunity for the state was a reversal of the Free Care Rule, a federal rule that barred reimbursement of Medicaid services that were already provided to students for free, therefore limiting reimbursement to those with IEPs. Now, states have “more flexibility to decide which types of services can be offered in schools and covered by Medicaid,” the research stated.
“In states that choose to take advantage of the flexibility, services provided by both school-employed and school-contracted health care professionals can potentially be reimbursed through Medicaid,” the study found.
But Ohio has not chosen to use that flexibility, a move that would require changes to administrative policies on IEPs and Medicaid reimbursement, as well as the submission of a state plan amendment.
The 2024-2025 state operating budget included goals from the Ohio Department of Medicaid to submit the plan amendment, possibly expanding eligibility for the Medicaid School Program and the covered services packages under the MSP, the HPIO stated, citing an August email from the ODM.
The department said it partners with the ODEW and 650 school districts and community schools to provide school-based health services for 125,000 students with disabilities in a year. In fiscal year 2022, participating school districts received $48 million in federal matching dollars, according to the ODM.
The most frequent services used as part of the Medicaid School Program in 2022 were group treatments of speech, language, voice, communication and/or hearing processing disorders, which made up 35 percent of the procedures used in that year by the program.
Expanding Medicaid-funded services in schools could ease financial constraints for schools while simultaneously improving student outcomes, though the HPIO acknowledged health care workforce shortages “may further complicate efforts to expand services.”
Still, statewide support could help bring implementation of new Medicaid services in school environments, as 26 others states have done.
“By paying the non-federal share (of Medicaid funding), these states are investing in their students’ health and learning, while also experiencing boosts in federal revenue,” the HPIO study concluded.
Susan Tebben is an award-winning journalist with a decade of experience covering Ohio news, including courts and crime, Appalachian social issues, government, education, diversity and culture. She has worked for The Newark Advocate, The Glasgow (KY) Daily Times, The Athens Messenger, and WOUB Public Media. She has also had work featured on National Public Radio.
Ohio Capital Journal is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
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