The Health Policy Institute of Ohio (HPIO) has raised concerns regarding the health outcomes of students in the state, particularly those enrolled in Medicaid, emphasizing the need for more school-based health care options. The group’s primary assertion is that healthier students lead to improved educational outcomes, thereby benefiting the broader state population. In a recently published report, HPIO advocated for investment in school-based health care services, which could enhance the future health and education landscape for Ohio’s youth. As policymakers and school administrations increasingly recognize the link between student health and academic success, HPIO also identified financial and administrative challenges that hinder the effective implementation of these health care services.
A significant change in federal policy in 2014 has the potential to improve absenteeism and overall health among students enrolled in Medicaid. The alteration permitted expanded Medicaid coverage for school-based health services, thereby allowing Ohio to potentially leverage Medicaid resources to address student health needs. According to the Ohio Department of Education and Workforce, over 700,000 K-12 public school students, or 42% of the total, were enrolled in Medicaid for at least three months during the 2022-2023 school year. Alarmingly, nearly 40% of Medicaid-enrolled children were deemed chronically absent, missing more than 10% of instructional time, a rate notably higher than their non-Medicaid peers.
The barriers to accessing healthcare for children from low-income families, such as inadequate transportation and parental work commitments, further highlight the importance of establishing school-based health services. While many school districts employ professionals such as nurses, psychologists, and counselors, the HPIO’s research indicates that the current staffing levels often do not meet the recommended standards set by provider associations. Moreover, some services offered by these professionals are not eligible for reimbursement under either public or private insurance systems, which may deter schools from expanding their health service offerings.
The Individuals with Disabilities Education Act (IDEA) mandates that students with special health care needs receive free and appropriate education, along with related services outlined in their Individualized Education Plans (IEPs). In the academic year 2023-2024, 17% of Ohio students had IEPs. Funding for these services comes from a blend of federal, state, and school district resources. The 2014 repeal of the Free Care Rule has allowed for greater flexibility in Medicaid reimbursement, enabling states to determine which services can be offered in schools. However, Ohio has yet to fully utilize this flexibility, necessitating modifications to both administrative policies regarding IEPs and Medicaid reimbursement protocols.
The 2024-2025 state operating budget contains proposals from the Ohio Department of Medicaid aimed at submitting a plan amendment that could broaden eligibility and service offerings within the Medicaid School Program (MSP). The department collaborates with the Ohio Department of Education and Workforce and over 650 school districts, providing school-based health services to 125,000 students with disabilities annually. In fiscal year 2022, participating districts secured $48 million in federal matching funds, predominantly for group treatments related to speech, language, voice, and hearing processing disorders.
Expanding Medicaid financial support for school health services could alleviate schools’ financial burdens while enhancing student health and academic performance. Nonetheless, the HPIO acknowledged that workforce shortages in healthcare could complicate the expansion of these essential services. A comprehensive effort at the state level might facilitate the implementation of new Medicaid-supported services, similar to initiatives already adopted by 26 other states, which have discovered that investing in student health not only improves educational outcomes but also increases federal revenues through the non-federal share of Medicaid funding.