The Looming Medicaid Crisis for Children—and Schools

As if school districts don’t have enough to worry about this fall with learning still lagging and attendance still flagging. With the end of the Covid-created federal public health emergency, millions of students are losing access to health care.

For the first time since early 2020, states can remove recipients from the Medicaid rolls if household income has increased or, in many cases, if families haven’t filled out proper paperwork. With child enrollment data from only 21 states, about 700,000 fewer children are enrolled in Medicaid and the number is likely higher given the limited data from states. Researchers at HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) projected that nearly three-quarters of children losing Medicaid would be disenrolled despite remaining eligible.

This has profound implications for education.

More than half of U.S. children receive their health coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Without access to health services, students are more likely to be absent from school and more likely to be distracted when they’re in the classroom. For young children, regular check-ups can help detect hearing and vision problems, as well as developmental issues, all of which are more easily addressed when spotted early. Research shows that health insurance for children is linked to better educational outcomes, including lower absenteeism levels and higher graduation rates. It’s also tied to better health and economic success well into adulthood.

The loss of coverage could also affect school districts’ bottom line. Districts receive an estimated $4 billion to $5 billion in federal Medicaid reimbursements for health services every year representing one of the largest streams of federal funding to public schools.

Ironically, Medicaid is able to support more in-school services than ever before. Initially the federal government allowed reimbursement only for services rendered to students with an Individualized Education Plan, but a 2014 rule change expanded reimbursement to pay for nurses, mental health counselors and other school health employees that serve all Medicaid-enrolled students. So far, 21 states have amended their Medicaid plans to allow for expanded reimbursement, and others are in the process of changing their plans. To help, the federal government earlier this year took steps to simplify the reimbursement process and encourage more districts to use the program: The Centers for Medicare & Medicaid Services (CMS) and the Department of Education released a series of new resources and regulation changes and launched a technical assistance center.

Educators have a role to play in preventing students from losing coverage, including by alerting parents to the need to follow the necessary steps of the Medicaid renewal process in their state and to appeal inaccurate disenrollment decisions. The School Superintendents Association (AASA) created a toolkit which includes sample letters, robo call scripts, social media posts and other helpful information to help schools communicate with families about how to keep their children enrolled in Medicaid. Teachers, nurses and counselors can also point families to state Medicaid agencies or enrollment-assistance organizations. For schools, keeping students covered and healthy should be an all-hands-on-deck priority.


Margaux Johnson-Green from Georgetown’s Center for Children and Families at the McCourt School of Public Policy contributed to this piece.