As public education comes under attack on a number of fronts, school leaders are sounding the  alarm about potential significant cuts to Medicaid. This federal-state partnership covers comprehensive and preventive physical, behavioral and mental health services and provides critical funding to K-12 schools and students.

Medicaid is among the largest federal funding streams for K-12 public school-based health and mental health services, helping to pay for $7.5 billion in services every year. It is also the largest source of federal funds to states; a significant federal cut would shift more costs to them, threatening major budget reductions in other state spending priorities — including for K-12 education. 

Medicaid provides health coverage to about 40% of America’s children, giving them access to the care they need to show up for school ready to learn. About 20% of children under 18 have a physical or mental health issue such as asthma, diabetes, vision impairment or anxiety that can affect their success in the classroom. If not appropriately managed, these conditions can adversely affect attendance, learning ability, motivation, academic performance and the chances of graduating from high school.  

To better understand what’s at stake, Healthy Schools Campaign and its partners — AASA,  Association of School Business Officials International, National Alliance for Medicaid in  Education and Council of Administrators of Special Education — surveyed school district leaders, administrators and staff to assess how steep reductions in federal funding would affect seven major areas: specialized instructional support personnel; mental and behavioral health services; student resources, including equipment and technology; prevention and early intervention services; care coordination and referral services; physical health services; and Medicaid outreach and enrollment services.

A total of 1,440 responses were submitted from all 50 states and the District of Columbia. Among the respondents, 45% identified their school district as rural, 34% as suburban and 17% as urban.  

The results clearly demonstrate the critical role Medicaid performs in meeting students’ needs — especially in rural districts, where a larger share of children are covered by Medicaid than in metropolitan areas and schools play an outsize role in providing health care. Respondents anticipate that the proposed cuts would deeply and negatively impact school health services and students’ ability to access the help they need to learn: 

• 80% of respondents expect reductions to school health staff and personnel, including  layoffs
• 70% expect reductions to mental and behavioral health services
• 62% expect a reduction in resources, including assistive equipment and technology for  students with disabilities
• 73% expect Medicaid cuts would lead to reductions across three or more of the seven major areas related to student health
• 90% anticipate that Medicaid cuts would lead to reductions across their district’s budget, outside of school health services. 

Survey respondents reported that Medicaid cuts will have serious negative effects on academic  outcomes and attendance, increase staff burnout and reduce quality of services; reduce  prevention and the availability of care; and add to families’ financial and emotional strain. 

“We would not have the capacity to support students with mental and physical health services  and purchase supplies needed to aid in education,” said one respondent, a school business official from Pennsylvania. 

“Students with speech issues would lose the early interventions,” a speech and language  paraprofessional from Nevada wrote. “We would not be able to help them, and future success  would be harder and create bigger gaps in their reading, math and social skills for lack of ability  to communicate properly.”  

“A reduction in mental health providers will directly impact access to care for all students,  reduced achievement, higher dropout rates, risk of court involvement and higher risk of suicide  and self-harm,” wrote a school psychologist from Michigan.

Since 1988, Medicaid has permitted payment to schools for medically necessary services  provided to children under the Individuals with Disabilities Education Act and documented in a  special education plan. In 2014, the Centers for Medicare & Medicaid Services clarified  Medicaid policy and allowed schools to seek reimbursement for all covered health services provided to all students enrolled in the program.

Today, 25 states bill for at least some services provided to all Medicaid-covered students,  including nursing and counseling by school psychologists. If the proposed cuts go through, states and school districts could be forced to raise taxes and reduce or eliminate programs, including health services for students. 

The survey respondents emphasize what is already clear — the proposed drastic reductions to the federal Medicaid program will harm students and impede them on their road to success. Medicaid is critical to ensuring that children are ready to learn and, eventually, enter into society and become part of their communities. 

Get stories like these delivered straight to your inbox. Sign up for The 74 Newsletter