School-Based Health Care Services in Danger

There are a lot of things that go into helping a child learn. Making sure they are healthy is one of those things.

If you are anywhere near my age, you would remember that we got multiple vaccinations in school — like for polio and smallpox — and those efforts virtually eliminated some of the most dangerous health threats for kids. Schools were a logical place to make sure every child was provided this life-saving care.

In more recent years, Medicaid funds from the federal government have helped school districts offer health services. And that assistance has become critical as schools have been held more responsible for addressing significant needs.

I know of a case that shows the benefit of in-school dental screenings. An elementary school screening showed tooth problems in a little boy that were at an emergency stage. The screeners said they were sure he was in pain. They also said kids like this one can get used to pain and don’t show it. In the end, the child got the attention he needed — because of the school screening. And, getting rid of the pain allowed him to focus on learning.

These screenings are supported through a Medicaid program called Early Periodic Screening Diagnostic and Treatment Benefits (EPSDT). Its focus is on low-income children, and it’s meant to help take care of health issues before they get worse – and more expensive to treat. It is just a few of the school services Medicaid funds.

But health care in schools is in danger. The American Health Care Act (AHCA), which passed the U.S. House of Representatives on May 4, would weaken — potentially eliminate  — the EPSDT program and impact all the health services schools provide.

The law would institute a Medicaid spending cap that would impact kids the most, because they make up about half of all beneficiaries under the program. It would also make some policy changes that target school-based care.

A group of about 60 education groups formed the “Save Medicaid in the Schools Coalition,” to preserve adequate Medicaid funding for students. In a letter sent this month to congressional leadership, they wrote:

“A school’s primary responsibility is to provide students with a high-quality education. However, children cannot learn to their fullest potential with unmet health needs… Schools deliver health services effectively and efficiently since school is where children spend most of their days. Increasing access to health care services through Medicaid improves health care and educational outcomes for students.”

Special Education Needs

The letter, signed by national organizations for school board members, administrators and teachers, explained that, besides the diagnostic screenings, Medicaid has covered important “medically-necessary” assistance for students who qualify for services under the Individuals with Disabilities Education Act (IDEA).

IDEA requires that students diagnosed with conditions ranging from learning disabilities to significant physical challenges receive an appropriate education. To help with meeting this requirement, school districts use Medicaid dollars to pay for specialized staff, like nurses and mental health therapists, equipment such as wheelchairs, hearing and vision devices, and accessible playground structures.

The Center for Budget and Policy Priorities (CBPP) points out that the federal government has never lived up to its commitment to fund IDEA. “Although the federal government committed in IDEA to provide 40 percent of the cost to educate children with disabilities, it has never met even half of that commitment.” Medicaid helps fill that gap.

Mental Health Services

Seven out of 10 children who receive mental health care get it at school. Those are needs that teachers are often not trained to provide, nor do they have adequate time to do so. Behavioral specialists, that Medicaid can help fund, address these issues more and more.

The AHCA says that schools would no longer have to be used for health care delivery, when we know kids get critical assistance – like mental health care – at their school. That change, coupled with reduced funding, would potentially eliminate essential school services.

Support Should Increase, Not Decrease

Currently schools get about $4 billion in Medicaid funding nationwide. Kentucky received almost $20.9 million in FY 2015. Jefferson County has gotten up to $2 million a year. It is worth protecting, and a case could easily be made for increasing this support.

Too often we expect excellence — even perfection — from our public schools, but we tie their hands in doing the things they really need to do to reach their goals.

Bottom line: the AHCA would disproportionately affect children with disabilities and children in poverty. Health services contribute to equity in education. No amount of school choice, or other current trend will address the health care needs of all children so they can learn. The U.S. Department of Education should be alarmed at such a proposal, and so should we.

About Debbie Wesslund

I served on the Jefferson County Board of Education, Louisville, KY, from 2007-2014 and continue to be an advocate for public schools. There’s a high-level dialogue about public education that swings from positive to negative, with many who seek the spotlight voicing an inaccurate picture of our public schools. Words matter. They get lodged in our public perceptions, creating a narrative that doesn’t reflect the real story. There’s so much more to public education, and much worth applauding in Kentucky and across the country. The stakes are high: public education is the most serious public business we are about as a community, a state and a nation. We must continually renew our resolve to support public education. There’s always more promise in building something up, than in tearing it down.
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