Keeping health in mind

Healthy students are better prepared to learn and succeed in school; and having a school nurse is one of the best ways to keep kids healthy. “Health in Mind: Improving Education Through Wellness,” an initiative of the Healthy Schools Campaign and the Trust for America’s Health, is seeking to reframe the conversation around health and wellness. In February 2012, the two organizations convened a meeting, hosted by the AFT, which brought together a diverse group of health service organizations as well as federal, state and local agencies to discuss how school nurses can have a voice in the conversation.

Chronic conditions like diabetes and asthma are the biggest cost drivers in healthcare today and, unfortunately, more students are coming to school with these conditions. Research shows that employing a school nurse is a cost-effective way to help manage chronic conditions as well as to promote healthier lifestyles. It’s the school nurse who often is responsible for providing early detection screenings, immunizations and health education. “School nurses often live in two worlds,” says Donna Mazyck, executive director of the National Association of School Nurses. “Each day, they straddle the line” between education and health.

NASN recommends one full-time school nurse for every 750 students. However, only 38 percent of public schools have a school nurse working every day. Funding is a major reason why there aren’t more full-time school nurses. And when it comes to school district priorities, school health often takes a back seat.

“People need to understand the reality of the work of today’s school nurses,” says Rochelle Davis, president and CEO of the Healthy Schools Campaign.

One goal of Health in Mind is to find new ways to pay for school health services. Money from Medicaid is one funding stream the group has explored in depth, because it could be an important source of funding for school health service. Even though schools are allowed to bill Medicaid for many of the services they provide, the complexity of Medicaid reimbursement often limits a school’s ability to obtain the funding, says Stephanie Altman, programs and policy director with Health & Disability Advocates.

The reimbursement that districts receive for the services provided by school nurses is restricted by a complex set of state and federal policy barriers, including laws governing Medicaid. “The barriers— real or perceived—have a chilling effect on school districts,” Altman says. Districts don’t have the guidance they need to navigate the tangle of regulations associated with reimbursement. Identifying strategies to address the barriers is an important step to improving these services.

Another way schools can fund health services is by teaming up with like-minded organizations. In California, for example, the San Jose Unified School District partnered with the Lucile Packard Foundation for Children’s Health and Packard Children’s Hospital to hire school nurses. Since the project’s inception in 2007, the district has decreased absenteeism, improved the care of chronic diseases, and boosted student reading and writing scores.

In Kentucky, the Hopkins County School District partnered with the local health department to provide school services. This has allowed the department to bill Medicaid for services delivered to Medicaid-enrolled students. Thanks to the reimbursement funds, the health department is able to provide one school nurse for every 535 students in the county.

“Efforts like these,” says Davis, help school districts and others to envision the impact that can be made if “we get a school nurse in every school.”