AFT Resolution


WHEREAS, improving compliance with state and federal requirements and streamlining the implementation of school-based Medicaid programs can yield a larger return on investment to participating districts; increase access to high-quality healthcare services for students; and allow districts and local unions more flexibility to protect and promote the work of school health providers, such as school nurses, occupational therapists/physical therapists, psychologists, speech pathologists/audiologists and social workers; and

WHEREAS, since at least 1997, federal guidance such as “Medicaid and School Health: A Technical Assistance Guide” has codified numerous barriers to school districts’ efforts to finance students’ equitable access to healthcare services offered by district employees; and

WHEREAS, several municipalities and national organizations, including the American Federation of Teachers, have sought clarity from the Centers for Medicare & Medicaid Services (CMS) about federal financial participation in school-based Medicaid programs, interpretations of relevant federal guidance and accurate reimbursement processes; and

WHEREAS, in December 2014, CMS released a letter to state Medicaid directors effectively dismantling the “free care rule” at the federal level; and

WHEREAS, in 2015, the U.S. Department of Education and the U.S. Department of Health and Human Services jointly released a toolkit, “Healthy Students, Promising Futures,” encouraging state agencies to better collaborate to address children’s health, including through attention to the role of school-based Medicaid programs to finance case management; and

WHEREAS, most states have not taken advantage of the December 2014 clarification, and piecemeal implementation across the country of this change, along with others, may exacerbate health equity issues; and

WHEREAS, under mandates of 2001 legislation, California has established exemplary infrastructure for excellence in its school-based Medicaid program, evidenced by an increase over 100 percent in federal financial participation in the first 10 years, as well as regular engagement of stakeholders at all levels, including school health professionals and their unions:

RESOLVED, that the American Federation of Teachers continue to clarify roles, responsibilities and pathways to progress among national stakeholders with partner organizations such as the National Alliance for Medicaid in Education, National Association of School Nurses, Healthy Schools Campaign and Trust for America’s Health, as well as federal entities such as the Education Department and CMS; and

RESOLVED, that the AFT raise awareness, especially among elected leaders, legislative teams and collective bargaining leads of state and local affiliates by developing a report on school-based Medicaid and increased federal financial participation that addresses the complexity and breadth of state programs, and offers concrete action steps; and

RESOLVED, that the AFT promote the regular collection and transparent analysis of performance indicators in school-based Medicaid programs by labor-management-community partnerships at the state and district levels; and

RESOLVED, that the AFT promote thoughtful and transparent reinvestment of federal reimbursement into school district initiatives that promote health, safety and well-being, as well as initiatives that protect and promote the work of school health providers; and

RESOLVED, that the AFT integrate messaging and campaigns around excellence in school-based Medicaid programs into existing membership engagement efforts, especially where there are opportunities to engage school health professionals in program review, redesign, implementation and evaluation; and

RESOLVED, that the AFT continue to encourage states to strengthen infrastructure for students’ health, safety and well-being, such as through community schools, school-based health centers and excellent school-based Medicaid programs, especially as they redesign accountability systems under the new Elementary and Secondary Education Act: the Every Student Succeeds Act.


Please note that a newer resolution, or portion of a resolution, may have superseded an earlier resolution on the same subject. As a result, with the exception of resolutions adopted at our most recent AFT convention, resolutions do not necessarily reflect current AFT policies.