In-School Healthcare Needs Payment Model Standardization Nationwide

By Nick Dobrzelecki, MBA, BSN, RN, Managing Partner and co-founder  

For the past couple of months we’ve addressed the need for school nursing reform and standards. In a nutshell, it’s high time that we have consistent guidance across every state regarding school nurse certification, education and specific job duties and roles. In the last of this series, we’re tackling what the payment model should look like for healthcare received by students. 

The health of students in K-12 schools is an important part of providing a safe learning environment and ensuring that kids are ready to learn. School nurses play a crucial role in children’s health, often the only medical professional that a child may have access to. As such, school nurse visits should be accessible to all students regardless of their ability to pay. To support this, the payment model for student healthcare services must be standardized and simplified from what we deal with today. Let’s look at the reasons why standardizing payment models is necessary and how it can help schools provide better healthcare to their students. 

Each school district across the U.S. has its own policy on how payments are handled, what types of insurance are accepted, and even if payments are required at all. This creates a confusing and often unfair financial system regarding student healthcare. In the state of Washington, as example, schools can bill the insurance companies directly for qualifying in-school treatment. In Ohio, however, as soon as the child is in the care of the school (including riding the bus to and from), a family’s personal insurance is not responsible for anything that happens on school property. This creates a large financial burden on school systems which can often result in the school deciding what they are or are not willing and able to pay for, putting students’ health at greater risk. 

This lack of standardization makes it difficult for districts to keep track of payments or ensure that every student receives equitable access to health services. It also causes confusion among parents who are not sure which insurance or payment option they need to use when seeking care from the school nurse. This can result in students with high acuity needs missing out on educational opportunities. 

Throwing one more challenge into the mix, many U.S. children are on Medicaid. Medicaid provides health services to students living in poverty who otherwise wouldn’t have access to doctors. Districts can receive reimbursement for the screening, diagnosis, and treatment of students’ health problems, often identifying and treating issues before they become more costly and challenging down the road. This is critical to help students in financial need get the healthcare they deserve, but it’s very challenging for school administrators who typically do not have a strong skill set in healthcare insurance reimbursement. 

Standardizing the payment process would make it easier for schools and parents alike. Schools could easily track payments and ensure that each student receives equal access to healthcare regardless of their financial situation. Parents wouldn’t have to worry about having different insurance plans or knowing which payment options their child needs when visiting the school nurse—they would know exactly what they need ahead of time. Additionally, by streamlining administrative processes, schools could save money on staff time spent processing payments and instead focus resources on providing quality care for their students. 

Additionally, payment standardization helps make student healthcare more accessible by removing barriers that prevent some families from receiving care from the school nurse due to financial constraints or confusion about what types of insurance are accepted by a particular district. This increases the likelihood that more students will receive medical attention when needed—which can lead to improved academic performance and overall wellbeing—and reduces unnecessary emergency room visits due to limited access to affordable care options within a given region.  

In conclusion, payment model standardization is essential in order for K-12 schools to offer quality healthcare services to their students while also providing equal access regardless of financial background or family income level. By streamlining administrative processes, schools can reduce costs associated with managing multiple payment options while improving accessibility so that every student has access to medical care when needed without fear of financial burden or confusion over which insurance plans are accepted by their district’s school nurse office. School administrators nationwide should seriously consider implementing standardized payment models in order to increase accessibility and reduce costs associated with managing multiple payment options while still providing quality healthcare services to their students.

We welcome any comments from you — do you agree with these thoughts? What ideas might you have to the contrary?

2 thoughts on “<strong>In-School Healthcare Needs Payment Model Standardization Nationwide</strong>”

  1. Nick, your blog seems to me to be indicating that there is a charge for students to see the school nurse. That is simply not the case. Some larger, high medicaid population schools do bill medicaid, but when that is the case there is no charge to the parent. I am unaware, and it has not been my experience that a parent’s private insurance has been tapped. Schools are required to pay for a 1:1 or private nurse if that in fact is needed. There may be a time when a school doesn’t feel a private nurse is needed and the parent chooses to have one. In that case, the cost goes to the parent. There is not a charge to any child who comes to visit the nurse. Your blog kind of made it sound like we hand them a bill on the way out the door

  2. Thank you for your comment, Pat. I believe there may have been a misunderstanding in the previous blog post. I was not advocating for students to be charged for all services they receive from the school nurse. Instead, the focus was on standardizing the payment model for healthcare services provided to students, such as preventive care services. This would allow schools to supplement their funding to hire school nurses and provide equitable access to healthcare services. By standardizing the payment model for Medicaid and private insurance, school districts could potentially cover the cost of having school nurses, especially in districts where funding is limited or where state laws do not mandate the presence of a school nurse. Thank you for your input, and I hope this clarification addresses any concerns you may have had about the previous blog post. – Nick

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