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Federal Officials Urge Collaboration Between Schools, Health Care Providers

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Schools should work to assess and meet the health needs of their students, and they should collaborate with healthcare providers to strengthen their efforts, says letter sent today by the U.S. Departments of Education and Health and Human Services. 

 "We know that healthy students are better learners who are more likely to thrive in school and in life," says the letter, which was sent to governors, chief state school officers, state health officials and state Medicaid directors. "In communities across the country, educators, health care providers, and families are working each day to help children grow into healthy and well-educated adults. They cannot do this alone. This work depends on strong and sustainable partnerships and commitments between health and education agencies at the local, state, and federal levels."

The letter is accompanied by a toolkit that details five practical ways schools can meet student health challenges through cooperative and innovative efforts. It follows years of efforts by groups like the Healthy Schools Campaign to provide more clarity about the legal and logistical issues surrounding such efforts.

Unmet health needs have real effects in the classroom, says the letter, signed by Acting Education Secretary John King and Health and Human Services Secretary Sylvia Burwell.

"Research strongly suggests that when young people receive necessary and preventive health care and have health insurance, their academic, health, and other important life outcomes improve," the letter says. "For example, one recent study found that children who gained access to Medicaid as a result of expanded coverage miss fewer school days due to illness or injury and are more likely to do better in school, finish high school, graduate from college and earn more as adults."

Here are the five recommendations detailed in the guidance.

1. Schools should assist students and their families with enrolling in public or private insurance.

The toolkit suggests school districts could modify their school enrollment forms to help identify families who may be eligible for Medicaid, state children's health insurance programs, or enrollment in health insurance marketplaces created under the Affordable Care Act. When the Mountain View School District in El Monte, Calif., made such a change and followed up to assist families in securing coverage, the number of insured students climbed alongside attendance rates, the guide says.

2. Schools should expand the Medicaid reimbursable services they provide to students.

Last year, the federal Centers for Medicare and Medicaid Services said that the so-called "free care rule" does not apply to schools. Before the clarification, it was unclear to many schools whether they could seek Medicaid reimbursements for Medicaid-enrolled students if those services were provided for free to other students. Advocates for low-income students said the guidance frees up schools to provide more on-site services, like mental health services, primary care, and preventative services, to eligible students.

By claiming such reimbursements, Hanover County Public Schools in Virginia has been able to bolster its school health staff and purchase equipment to help meet special health needs of students, the guide says.

3. Schools should consider using Medicaid funds to support case management for wraparound services.

"LEAs and schools can, in accordance with an approved state Medicaid plan and applicable federal privacy laws, use Medicaid funding to support district and school-based case managers, who can work to connect Medicaid-enrolled students in schools to necessary health care and related support services (e.g., housing, transportation)," the toolkit says.

Wraparound and support services, often provided by community schools, help students who are "low-income, chronically absent, homeless, or otherwise at risk of falling behind in school" by connecting them with resources like food pantries, free mental health care, and counseling services. 

4. Schools should support healthy eating, physical activity, and health education.

Schools should incorporate strong school wellness plans into their improvement strategies, the toolkit says. They should analyze how well their health curriculum aligns with national benchmarks and integrate opportunities for physical activity and healthy eating into the school day, it says.

5. Schools should partner with local hospitals to assess and meet community needs.

"Under the Affordable Care Act, hospitals claiming 501(c)(3) charitable, tax-exempt status must conduct a community health needs assessment (CHNA) at least every three years (beginning in 2012/2013) and adopt strategies to address prioritized needs," the toolkit says. "Hospital CHNAs can help launch productive partnerships between hospitals and schools because nonprofit hospitals are required to consult with community members and public health experts as part of the CHNA process. Schools and school districts can also partner with many other kinds of community based organizations to enrich the health services available to students."

The guide lists examples of successful partnerships that led to a large network that provides on-site care for students, a program to promote early literacy, and an effort to tackle attendance issues.




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