Child Health

Expanding Critical Children’s Health Access in Ohio’s Schools

March 8, 2023 | Ohio

Expanding Critical Children’s Health Access in Ohio’s Schools

By Alison Paxson, Senior Policy Associate | March 8, 2023

We all play a part to ensure every child can experience hope, health, happiness, and be supported to thrive.

Student physical health, mental health, and overall wellness are critical foundations for success in school and life, but according to the 2020-2021 National Survey of Children’s Health, an estimated 58,000 school-age children in Ohio were not able to access needed health care. This lack of access to care is concerning, especially as children and youth grapple with growing mental and behavioral health challenges.

In Ohio, for instance, nearly 1 in 8 children received a diagnosis of anxiety, depression, or both in 2020, up 42% – the 10th highest increase nationwide.

Further, data from the most recent Youth Risk Behavior Survey conducted by the Center for Disease Control and Prevention shows that nearly all indicators of poor mental health and suicidality have increased for adolescents in the United States. In fact, among teenage girls alone, nearly 3 in 5 reported feeling persistent sadness in 2021 and 1 in 3 seriously considered attempting suicide. Tragically, more than 20% of LGBTQ+ students did attempt suicide. Overall, when we look across all racial and ethnic demographics, we see that feelings of persistent sadness or hopelessness increased among children and youth nationwide.

“I think there’s really no question what this data is telling us,” said Dr. Kathleen Ethier, head of the CDC’s adolescent and school health program, in an interview with The New York Times. “Young people are telling us that they are in crisis.”

Given that this youth mental health crisis started well before the COVID-19 pandemic, it is beyond time we listened to them.

Fortunately, addressing child mental health needs is featured prominently as part of Governor DeWine’s proposed Executive budget priorities for FY2024-2025. This includes investments to address workforce shortages of pediatric behavioral health professionals, to develop research and best practice through creation of the new “State of Ohio Action for Resiliency Network” or the SOAR Network, and critically, the expansion of children’s health access in Ohio’s schools by modernizing our Medicaid in Schools program (MSP).

In Ohio, nearly half of all children (48.3%) have health coverage through Medicaid and our state’s Children’s Health Insurance Program (CHIP). And in more than 40 school districts in the state, Medicaid and CHIP cover more than 50% of students. Research shows that these children are more likely to attend school regularly, graduate from high school, and complete college than those without health insurance. But to lead healthy lives and thrive, children need access to the care that insurance allows. To ensure that all children can get the care they need, we must provide health services – mental, behavioral, and physical care – and support where children spend most of their time: school.

School-based care is critical to a strong support system for all students. But for the more than 1.3 million Ohio children enrolled in CHIP who are part of low-income families, parents are often working jobs in which taking time off to bring a child to the doctor means lost wages. Having care in school for these children could be the difference between them being seen by a health care professional or not. Strengthening access to school-based health care also helps in preventing lost learning time for students, can improve school culture and climate as well as community infrastructure by bolstering local school buildings as trusted neighborhood hubs, and is an evidence-based strategy to reducing our state’s skyrocketing rates of chronic absenteeism.

Currently, Ohio’s Medicaid in Schools Program (MSP) blends state and federal dollars to pay for physical and mental health services in schools for Medicaid-eligible students – but it is limited to only those students with an individualized education plan (IEP). This means that there are thousands of Medicaid-enrolled students in Ohio whose access to care in-school may be limited because they don’t have an IEP and the school isn’t able to bill Medicaid for the cost of services. By requiring that students have an IEP to have Medicaid cover their care in school, we are preventing schools from being able to fully serve a large number of low-income students, including providing vital mental and physical health supports.

However, the DeWine Administration’s budget proposal includes a crucial commitment to join 17 other states – including our neighbors Michigan, Indiana, and Kentucky – in seeking permission from the Centers for Medicare and Medicaid Services (CMS) to reimburse schools for health services provided to any Medicaid-eligible student. This would dramatically increase access to children’s health services without additional state investment. For the many Ohio schools already providing school health services, this waiver will allow for federal dollars to cover around two-thirds of their existing costs, allowing for significant expansion of current services that are offered with no additional state general revenue required.

Importantly, when we improve access to Medicaid in our schools, we are not only supporting the physical and mental health of our students; we are supporting our schools. Some schools use Medicaid to pay for school nurses, mental health counselors, and other health care programs, including providing immunizations. By broadening access to Medicaid in schools, schools in Ohio are more likely to have access to the health care personnel and equipment they need. As a society, we all stand to benefit from improving school health care sustainability and eliminating barriers children and youth face accessing these direly needed supports.

As an organization, we commend the DeWine Administration’s recognition of the urgent need to address child and youth mental health challenges and applaud their commitment to pursuing the MSP waiver in addition to allocating funding to a new school-based health center appropriation line item that can help expand the footprint of school-based services in Ohio. We urge state lawmakers to ensure these items remain intact as part of our state’s final budget in July.

One way CDF-Ohio and our partners are advocating to make our commitment to improving the Medicaid in Schools Program even stronger is by ensuring our state budget includes specific language that directs the Ohio Department of Medicaid to pursue this waiver in a timely manner by the end of 2023. (See our new one-page fact sheet linked below for more detail.)

While the challenges facing children, youth, and our communities are vast, we have the research to support data-driven solutions and the resources to enact them. Expanding access to school-based health services is one critical way we must show our children we are listening to them and committed to ensuring their hope, health, happiness, and ability to thrive.

Download our one-page fact sheet outlining our budget recommendations for the Medicaid in Schools Program to improve student access to school-based health care.