The relationship between Medicaid and school nurses is significant, as Medicaid plays a crucial role in funding school-based health services, including the work of school nurses.
School-age children comprise nearly one-third of all Medicaid enrollees (view state and school district data on Medicaid and CHIP enrollment). Medicaid is the fourth largest funding source for K-12 schools, supporting physical, mental and behavioral health services for Medicaid-enrolled students with disabilities and the general education population. It provides vital healthcare access where children spend most of their day.
Here’s how school nurses and Medicaid are connected:
1. Medicaid Reimbursement for School-Based Health Services
- Medicaid covers certain health services provided in schools, particularly for students who qualify under the Individuals with Disabilities Education Act (IDEA). These services often include:
- Nursing services (e.g., medication administration, chronic disease management)
- Speech therapy, occupational therapy, and physical therapy
- Screenings
- Specialized equipment
- Mental health counseling
- School districts can bill Medicaid for these services, which helps offset the cost of employing school nurses.
2. Expanding Access to Care
- School nurses are essential in ensuring Medicaid-eligible students receive necessary health care. They facilitate:
- Enrollment in Medicaid and CHIP (Children’s Health Insurance Program).
- Preventive care, such as immunizations and screening.
- Chronic disease management for conditions like asthma, diabetes, and epilepsy.
- By providing services in schools, Medicaid reduces barriers to care, particularly for students in low-income, small, rural and underserved communities. See Medicaid's Role in Small Towns and Rural Areas from Georgetown University McCourt School of Public Policy.
3. Medicaid’s Role in School Health Infrastructure
- To date only 25 states have taken steps to expand their school Medicaid program to cover services outside of an Individualized Education Plan (IEP), helping provide additional revenue and offsetting costs for services. See the School Medicaid Expansion Map from Healthy Students, Promising Futures.
- Medicaid helps cover state and district budget gaps, and means less dependence on property taxes and levies.
- Schools deliver health care services effectively and efficiently since children spend the bulk of their time at school. Access to health care services through Medicaid improves health care and, as importantly, academic outcomes.
- Strong school-based Medicaid programs rely on a strong Medicaid program. Cutting Medicaid is equivalent to cutting school district budgets.
NASN firmly believes Medicaid is a critical funding source for school health services, Expanding Medicaid reimbursement for school-based care can enhance student health, reduce health disparities, and support school nurses in delivering essential services.