Investing in school-based and school-linked health services would help ensure that students receive the physical and behavioral health care they need to reduce chronic absenteeism and improve school performance. Ensuring that all students attending public school have access to basic health care services would help address and improve realities that do not bid well for the health and education of many of our students.
Approximately 6 to 7 percent of school-aged children miss 11 or more days of a typical school year in North Carolina because they are sick or injured. Around 6 percent of school-aged children do not have health coverage, and many low-income families and children face additional social, environmental, and financial barriers regarding access to health care services (e.g. a parent’s ability to take time off work to take their child to the doctor). Nationally, around 27 percent of children 19 years and younger have a chronic health condition, which may affect school achievement and attendance.
These are realities that we can and should address.
School-based health centers (SBHC) and school nurses are in a special position to help increase access to health services for children as their role is to collaborate with school personnel and other community groups that work with schools. Thus, SBHC staff and school nurses are capable of not only educating students about school violence, healthy behavior promotion, and disease prevention, but they also can work with teachers, parents, and school personnel on promoting school policies that promote a safe and healthy school environment. School nurses and SBHC staff can provide health care services if a child is injured, participate in crisis intervention, and make referrals to other health services. North Carolina has a persistent deficit in regards to school nurses. Health People 2020 recommends that the proportion of full-time registered nurse to student ratio be 1 nurse for every 750 students; however, North Carolina has a ratio of 1 nurse for every 1,177 students, which is far from the recommended ratio. Moreover, only 90 SBHCs serve just 25 of North Carolina’s 100 counties.
North Carolina lawmakers have several opportunities to strengthen children’s ability to gain health coverage and receive affordable health services. Expanding Medicaid is one opportunity as more than half of parents in the current health insurance coverage gap have school-aged children. When parents have health coverage, children are more likely to be enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Furthermore, changes at the federal level now enable schools to bill the Medicaid program for health services provided to Medicaid-eligible children. In 2012, nearly 1 million North Carolina children ages 18 and younger had Medicaid health coverage. Currently, schools are only reimbursed for health services provided at school if the services are medically necessary and if the student is eligible for both Medicaid and special education. Accordingly, North Carolina’s education and health agencies can work together to develop a state plan amendment so that all Medicaid-eligible children can receive the behavioral and physical health care they need.
Through thoughtful public policy decisions and collaboration, we can ensure that North Carolina students have all the tools they need for a successful school year, including access to health care services.