Rural Health Policy Project

Report: Children in Rural Communities More Likely to Rely on CHIP and Medicaid

The challenges that students face in many rural places are staggering

The challenges that students face in many rural places are staggering. Limited access to advanced coursework, medical care, food, and employment opportunities continue to daunt students in many rural communities. Poverty rates are also climbing. In 23 states, a majority of rural students live in low-income households; this is a noticeable uptick from 2013 when only 16 states had a majority of rural students who were from low-income families.

But what can we as a country do to better support rural students, so they have a more equitable opportunity to succeed?

Leveling the Playing Field for Rural Students is a new report from AASA, The School Superintendents Association, and The Rural School and Community Trust that describes how Congress can support or amend current federal policies to improve equity for the one in six children living in rural communities. Specific to the Say Ahhh! readership, I wanted to flag policy recommendation No. 2, which describes the role Congress can play in addressing health barriers that impede learning for rural children.

While it’s widely understood that kids cannot learn to their fullest potential with unmet health needs, access to health care providers and insurance can be difficult for children in rural communities. A 2014 report by First Focus found that 45 of the 50 counties in the U.S. with the highest rates of uninsured children are in rural areas.

Children in rural communities are 24 percent more likely than those in urban areas to rely on CHIP and Medicaid for health care. One of the reasons is that the overall poverty rates are higher for rural children, and the types of jobs in those communities, such as agriculture or small businesses, are less likely to offer insurance. Further, seasonal workers or those with cyclical employment are more likely to live in rural areas and less likely to have insurance. This means accessing insurance through a parent’s employer is not a reality for many children in rural America.

Finding a sufficient supply of healthcare providers in sparsely populated areas is another obstacle to rural students. Other barriers include finding transportation to and from the provider’s office; paying for healthcare services, medications, or treatment; and navigating language or communication barriers and privacy concerns.

These issues, coupled with rural children’s high rates of eligibility for federally supported healthcare services, means that some rural schools must regularly deliver critical health services to students. Rural schools often rely on Medicaid and CHIP funding to hire healthcare providers like school nurses, purchase medical supplies and equipment, and diagnose, screen, and treat children’s ailments. Rural school districts also assist families in enrolling in CHIP and Medicaid, so they can qualify for healthcare.

Even as children in rural areas are more reliant on schools for healthcare than those in metropolitan areas, rural schools are more likely to lack nurses to meet the various medical needs students have. Twenty-four percent of rural schools have no nurse, compared to 10 percent of urban schools.

Children in rural communities are 24% more likely to rely on CHIP and MedicaidWhile school-based Medicaid funding can be used to ameliorate the shortage of school nurses, rural districts are less likely to bill Medicaid for school nurses than other districts. Only 32 percent of rural schools bill Medicaid for school nurses compared to 52 percent of urban districts. This is mainly due to the enormous administrative challenges that come with billing Medicaid that make it more difficult for rural districts to participate in school-based reimbursement systems.

Of particular importance to communities in rural areas is the ability of rural children to access the mental health and substance abuse treatment they need. Nationally, seven out of 10 students receiving mental health services find these services at school. But with chronic shortages of mental health professionals in rural areas, many children and families cannot access these providers anywhere else.

The report concludes with three action steps Congress can take to address health barriers to learning for rural children. They are:

  • Extend funding for CHIP for five years at current funding levels.
  • End efforts to cap Medicaid funding as this would limit the reimbursement schools receive for providing critical healthcare services to Medicaid/CHIP beneficiaries.
  • Work with CMS to find ways to reduce the administrative burden on districts that rely on Medicaid to fund critical health personnel in school, which will enable rural districts greater access to school-based Medicaid reimbursement for these positions.
Sasha Pudelski is assistant director of policy and advocacy for AASA, the School Superintendents Association.

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