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States Can Do More to Leverage Federal Funding to Support School Based Health Services

Alexandria, VA – School-based health services (SBHS) are a powerful, yet underused strategy to expand equitable healthcare to students, according to a new analysis from NASBE.

The analysis finds many states can take better advantage of federal funding streams, such as Medicaid, to build and enhance school health services. Currently, only a third of states take advantage of federal flexibility to bill Medicaid for all eligible school health services provided to Medicaid-enrolled students. More states can also leverage ESSER and Project AWARE funds to expand mental and behavioral health services, such as Oklahoma, Arkansas, Louisiana, and Wyoming have done.

There are effective strategies states can employ to increase access to SBHS and questions education policymakers can ask to elevate this issue at the decision-making table in partnership with their state health leaders. For example, states can create state-level advisory councils to advise decisionmakers on student health issues, which nine states require. Another promising strategy, school-based health centers, can particularly benefit low-income households, yet only about 2 percent of U.S. schools have one in operation. Ensuring schools have trained medical personnel equipped to meet student needs is another effort worth exploring with Vermont and Delaware requiring every school to have a school nurse.

“At a time when the nation is combatting a youth mental health crisis and federal education funding is at an all-time high, state leaders can do more to leverage federal funding streams, partnerships, policies, and capacity building to expand SBHS,” writes NASBE’s director of safe and healthy schools Megan Blanco.

Read Enhancing School-Based Health Services.

NASBE serves as the only membership organization for state boards of education. A nonpartisan, nonprofit organization, NASBE elevates state board members’ voices in national and state policymaking, facilitates the exchange of informed ideas, and supports members in advancing equity and excellence in public education for students of all races, genders, and circumstances. Learn more at

This publication is supported by cooperative agreement CDC-RFA-PS18-1807, funded by the Centers for Disease Control and Prevention (CDC). The contents of this publication are solely the responsibility of the author and do not necessarily represent the official views or endorsement of the CDC or the Department of Health and Human Services.




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