A nationwide survey of K-12 school district leaders shows widespread concern over children’s access to school-based health services if Congress cuts Medicaid.

The survey and companion report from the Healthy Schools Campaign includes analysis and dozens of comments from respondents about the expected hardships for students, schools and communities. More than 1,400 school district leaders, Medicaid coordinators and health providers from all 50 states and D.C. completed the survey.

Almost half of the respondents are from rural school districts, where more children are covered by Medicaid (known as Medi-Cal in California) and schools play an outsize role in providing physical, behavioral and mental healthcare due to provider shortages, long travel distances and limited connectivity.

Among the survey findings:

“School district leaders were clear: Since some services are mandated, Medicaid cuts would lead to school district budget gaps, which could mean tax increases for communities. Cutting Medicaid is equivalent to cutting school district budgets,” the report says. “Congress, therefore, must reject all proposals to reduce Medicaid funding. To do otherwise is to reduce protections for our country’s most vulnerable students.”

Medicaid provides medical coverage to around 40 percent of all children under the age of 18 in the U.S., according to the report. Schools can seek reimbursement from Medicaid for screening, diagnosis and treatment services they provide to students enrolled in Medicaid, providing more than $7.5 billion in school health services every year.

“It serves as a significant source of revenue for schools, making Medicaid the fourth-largest federal funding stream for K-12 public schools,” according to the report.

In February, House Republicans approved a budget resolution that directs the House Committee on Energy and Commerce to reduce the federal deficit by a minimum of $880 billion over the next 10 years.

“While Medicaid is not explicitly referenced, budget analysts expect that a significant portion of these cuts would come from Medicaid due to the committee’s jurisdiction of the program,” the report states. “The budget process has many pivot points, but it’s clear that federal funding for Medicaid is at risk.”

ACSA and the California School Boards Association have sent a joint letter to California congressional representatives urging them to reject any reconciliation measure that shifts health care responsibilities to local school districts.

If funding is cut, survey respondents said they would not be able to hire quality candidates to provide vital services to students, especially those with disabilities and mental and behavioral health needs.

“Our students with behavioral health needs require additional personnel, time and space to work through their regulation processes,” said one Medicaid coordinator & billing specialist from a rural district in Idaho. “Without this funding, we would see increases in student and staff injuries, decreases in learning and test scores across subjects and decreases in enrollment resulting from the unsafe environment.”

Districts also said cuts would impact all students, with 90 percent of respondents saying they would be forced to cut other areas of their budget to pay for these necessary services.

“Lower Medicaid reimbursement simply shifts the burden onto local taxpayers,” said one superintendent in a rural district in Iowa.

Many respondents also made the point that preventative care provided through schools improves attendance and ultimately saves communities money by preventing more costly hospitalizations, trips to the ER and incarceration.

“Medicaid cuts will cause districts to shift focus from students with mental and behavioral health needs since schools cannot manage needs with decreased funds,” said a director of student services from a district in rural Wisconsin. “This will lead to an uptick in absenteeism, disciplinary issues [due to unmet needs], and need for alternative options. For students with mental/behavioral health needs but without family support, incarceration is more likely. This increases costs to our community.”

Healthy Schools Campaign developed and distributed the survey in partnership with The School Superintendents Association; Association of School Business Officials International; National Alliance for Medicaid in Education; and Council of Administrators of Special Education. The survey was distributed Jan. 27-March 3.

Read the full report at content.acsa.org/how-medicaid-cuts-will-harm-students-schools.