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Medicaid provides health coverage to almost half of America’s children, giving them access to the care they need to show up for school ready to learn. Children covered by Medicaid are more likely to receive the preventive health care that keeps them in school, annual checkups that allow them to participate in sports, and treatment when they are sick or injured. All those benefits add up to stronger, healthier students — boosting both school achievement and economic prosperity as adults. In fact, research shows us that students eligible for Medicaid are more likely to graduate from high school and complete college than students without access to health care. And a 2023 Congressional Budget Office analysis found that just one extra year of Medicaid coverage during childhood leads to higher earnings and better productivity as an adult, boosting the nation’s economy.

Too often, children falling behind in the classroom suffer from undiagnosed health issues. Perhaps they need glasses to read the board. Or a toothache is making it hard to concentrate. Or an undiagnosed learning disorder like ADHD is keeping them from achieving their full potential in school. Medicaid’s robust pediatric benefit package allows for early screening to identify these barriers to success and intervene early. That can bolster early education initiatives aimed at getting all children ready for kindergarten, as well as broader efforts to ensure every child masters reading by the end of third grade. One study found that increases in Medicaid eligibility at birth led to improvements in reading test scores in the 4th and 8th grades. Another analysis found a boost in children’s reading scores when their
parents became newly eligible for Medicaid coverage.

As school districts across the nation struggle to bring down absenteeism rates, Medicaid has an important role to play. Illness is still the No. 1 reason that students miss school, and too many absences contribute to weaker social-emotional skills in kindergarten, poorer reading skills in third grade and higher dropout rates. Beyond physical ailments, mental health challenges are keeping many students from showing up for school. When asked why they missed class, 16 percent of high school students cited anxiety, and another 12 percent listed sadness and depression, according to a fall 2023 survey. Medicaid is supporting efforts to provide mental health support for these students.

Many schools use Medicaid to pay for the personnel, services, and equipment they are required to provide disabled students who have Individualized Education Plans. These costs can range from physical therapy sessions to transportation to specialized equipment for severely disabled children. Under the federal Individuals with Disabilities Education Improvement Act, Medicaid provides funding for eligible medical and related services for students with disabilities, helping schools offer increased access to necessary care.

Medicaid is also a key source of funding for school-based health care provided to all eligible students in many states. Local hospitals or health systems that operate health centers within schools can charge Medicaid for the care they provide to eligible students. In some states, school districts seek reimbursement directly from the program under a decade-old provision that allows for broader use of such funding. In Louisiana, Medicaid funding helps pay for nursing services delivered to Medicaid-enrolled students, among other priorities. In Arkansas, it’s supporting the increased demand for mental health services. In June 2024, the federal government provided $50 million in grants to 18 states working to implement, expand or enhance school-based health services for Medicaid-eligible students. Among them are several states, including Alaska, West Virginia, and Wisconsin, that are just starting the process.

School-based health care plays an especially important role in rural areas, where families often have to drive long distances to see a doctor or reach a hospital. With support from Medicaid, rural schools can not only provide on-site nurses and health providers, but can access mental health therapists and medical specialists through virtual connections. After the pandemic, most states began allowing use of Medicaid funds to pay for telehealth options. Colorado, for instance, permits schools to bill for telehealth services including behavioral health care.

Considerations for Congress

As Congress contemplates changes to Medicaid financing, the decisions made on Capitol Hill could have a profound impact on children’s health and school achievement. One third of Medicaid recipients are between ages 5 and 18, and any cuts to the program for these children or their parents would make it harder to access the care they need to support healthy development and school success.

Cutting Medicaid, including through block grants, caps or changing the financing structure, would end up leaving school districts competing for more limited state dollars. Such steps could well mean that families might not be able to count on the early screening that identifies learning challenges and no longer rely on school-based health services. Academics would suffer, as would school attendance.The long-term impact of cuts would make the U.S. less competitive, the Congressional Budget Office found.

Federal Medicaid cuts would have ripple effects into K-12 education funding as states struggle to fill gaps in health care shortfalls. The cuts would add to the stress on local governments, which would either have to cut school budgets or raise taxes. If our nation is going to keep its competitive edge into the future, we need to keep our school desks full of healthy children ready to learn. Medicaid provides a critical link between students and success.