Attendance Works News

February 10th, 2016

Revised Medicaid Policy Can Increase Access to Health Services At School

Alex Mays, Senior Policy Analyst, Healthy Schools Campaign

We know that student health issues are a leading cause of chronic absenteeism. So making sure that kids have access to school health services – physical, dental, and behavioral – is an important part of strategies to reduce chronic absenteeism. The US Centers for Medicare and Medicaid Services (CMS) recently took an important step towards increasing access to school health services for students. In a letter to State Medicaid Directors, CMS removed a major barrier to school-based health care services and clarified that the free care policy does not apply to schools.

Since 1997, the free care policy has made it difficult for schools to receive Medicaid funds to pay for services that are available, without charge, to everyone in the community. Since school health providers serve the entire school community, many of the services they provide to Medicaid beneficiaries were considered not eligible for reimbursement. As a result, school health providers are typically underfunded and many students across the country do not have access to regular school health services. For example, less than 50% of students have access to a full-time school nurse, according to research from the National Association of School Nurses.

Research supports a clear link between providing kids better access to school health services and a drop in chromic student attendance. Allowing students to receive health services at school is a proven strategy for addressing the health conditions that interfere with a child’s ability to learn. This is especially true for younger students in K through 3rd grade, where research shows that just two days missed per month, whether excused because of illness, or unexcused, leads to academic trouble for students as early as the 5th grade.

The reversal of the free care policy presents an opportunity for schools and districts to increase access to school health services for students. The change also can make it easier for districts to provide the medical care and attention that many students need to stay healthy, so they are able to attend school every day. Student illnesses, such as colds and earaches, to more long-term health challenges such as asthma, diabetes, vision impairment and mental health issues, are a leading cause of chronic absenteeism.

The free care policy has been the focus of dispute for a number of state agencies. In 2004, the U.S. Departments of Health and Human Services ruled that the free care policy, as applied to school districts, has no basis in federal Medicaid law, and is unenforceable when applied to schools. In keeping with this ruling CMS recently agreed to reimburse the San Francisco Unified School District for health services delivered to the general student population by school health professionals. Advocates such as Healthy Schools Campaign, Trust for America’s Health and the National Alliance for Medicaid in Education, have been working over the past decade to clarify that the free care policy does not apply to school-based health services.

There is still some work to be done. Before schools can apply for Medicaid reimbursement for health services, each state must decide to allow school districts to bill for additional health services delivered to students. In many states, this will require an amendment to the state Medicaid plan. Louisiana and South Carolina have already passed amendments to their state Medicaid plans to allow school districts to seek reimbursement for additional school health services, and California is not far behind.

One of the most important next steps in implementing this change will be supporting state-level efforts to implement the reversal of the free care policy. To better understand what the change in the free care policy means in your state, and how to leverage this opportunity to support student health services, and boost school attendance check out this stakeholder’s guide on the free care policy created by Healthy Schools Campaign.

We encourage you to spread the word about this recent change and the role that school-based health services can play in reducing chronic absenteeism in your community. We view it as a major important step forward in providing health care for students, especially for low-income students who may not have access to affordable health care. This revised policy also clearly supports the important connection between good health, learning, and student achievement.


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January 22nd, 2016

Brainstorming With Public Works About Winter Weather Challenges

The school district in New Britain, Conn., has reached out to the city’s Department of Public Works to find solutions around transportation challenges for students traveling to school during inclement winter weather. The collaboration marks the beginning of a conversation with the city agencies about how snow removal, traffic congestion and other issues affect school attendance, said Joe Vaverchak, New Britain’s Director of Attendance.

The Consolidated School District of New Britain is an urban district serving slightly over 10,000 students, many who live in high poverty. Many of the district’s students walk or take the bus to school. Heavy snow presents real challenges for children trying to get to school and sometimes even keeps students stranded at home. During last school year’s brutal snowfall, piles of snow in New Britain were so high at bus stops that students had to wait in the street, posing dangers for both students and the drivers trying to get to work. Walkers were equally affected by sidewalks that remained uncleaned for up to several days.

Jim Williamson, President of the Community Foundation of Greater New Britain,
convened a meeting to discuss the situation after Vaverchak and James Jones, CFGNB Board member and a local school administrator suggested that the city’s public works department could make a difference in improving winter school travel. Jones had tracked attendance data from the prior winter, which showed the direct relationship between street and sidewalk cleaning and an increase in chronic absence at his school. The meeting took place in November with representatives from the Community Foundation, Department of Public Works, Vaverchak and Jones. “The meeting was a simple connect-the-dots exercise which will help assure that more students attend school regularly – and arrive safely when they do,” Williamson said.

The group discussed the areas of the city with streets that could be dangerous with too much snow, and brainstormed solutions such as preparing the streets before snow falls or making certain streets a priority for snow clearing. They also talked about moving bus stops to safer locations, and strategically placing buses best equipped for snow in the most difficult neighborhoods.

The conversations began with both sides learning something, Vaverchak said. The public works department wasn’t aware of the distances that many kids travel to get to school, and the district learned of certain areas in the city where snow build up could keep cars from getting through. “Schools can’t do it themselves. We should be working together, since we are all trying to solve the same issue,” Vaverchak said.

The district plans to reach out to the police department as well as the bus company that works with the district to join the next meeting. The police “can be the eyes out there because even in a blizzard they are still out there patrolling,” Vaverchak added.

The New Britain school district has already made important gains in improving school attendance, having reduced absenteeism in kindergarten by 44% since 2011. Attendance across the K-3rd grades has improved 38.25% over that same time period. Working with community stakeholders to improve school travel during the winter months is another part of the district’s commitment to reduce absenteeism for students at all grade levels, Vaverchak said.

Our winter toolkit provides resources for parents, schools and community members to help overcome winter-related challenges. Find the toolkit here.

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January 20th, 2016

ESSA Guidance Should Focus On Effective Use of Chronic Absence Data

The US Department of Education invited comments on the Every Student Succeeds Act (ESSA), signed by President Obama on Dec. 10, 2015. After reaching out to our partners for input, we submitted recommendations for the creation of guidance around the chronic absence provisions in the new law. The ESSA requires that states report chronic absenteeism rates, and allows districts to spend federal dollars on training to reduce absenteeism.

The comments encourage the DOE to create guidance that we believe will ensure the effective use of chronic absence data. You can see a summary of our comments below. Click here to read the full comments that we submitted on Jan. 21, 2016. Several partners built upon our recommendations to craft their own. You can also read the comments from California’s Attorney General.

Our comments reflect our delight that the ESSA recognizes that no one measure of success is sufficient for examining whether a school is effectively meeting the needs of its students. In particular, we appreciate the requirement that schools must report on chronic absence (missing too much school for any reason). Armed with this information, schools—often together with community partners—can help students get the additional supports they need to overcome barriers to getting to school. After all, students will only benefit from our investments in high quality instruction and teaching if they are in the classroom.

Our recommendations include:

1. Encourage districts to take an early warning approach. Advise schools to monitor when students miss 10% or more of school and use those data to trigger intervention throughout the year. Guidance should recommend that districts provide reports to schools on which and how many students are at risk of missing too much school on a weekly or bi-weekly basis, if not in real time. Timely access to such data is essential to prevention and early intervention.

2. Adopt a common 10% reporting requirement. One challenge with the 15-day measure is that it does not correspond to the 10% definition cited by other federal agencies (for example, in the newly launched Federal initiative on chronic absenteeism, Every Student, Every Day) and already being used by numerous states. Connecticut, Indiana, Iowa, Mississippi, New Jersey, Ohio, Oregon, Rhode Island, and Tennessee have already begun producing reports on how many students are missing 10% or more of school. A common reporting requirement would reduce confusion as well as allow for better comparisons across states and localities.

3. Encourage school districts to message to families about the impact of chronic absence. School districts must allocate at least 1% of Title I dollars for parent engagement. Encourage districts to use these resources to help parents understand why daily attendance matters and what steps they can take to nurture a habit of attendance as well as get help with addressing barriers to getting to school.

4. Encourage schools to incorporate attention to attendance into a multi-tiered system of support (MTSS). Such an approach will encourage schools to focus on prevention and early intervention and leverage a framework that many educators are familiar with. Title II funding could be used to support such professional development.

5. Encourage districts to identify and enlist community agencies in addressing chronic absence. Encourage districts to forge partnerships with public agencies and non-profits. Include information about how data can be shared without violating confidentiality requirements.

6. Support the inclusion of chronic absence data in school report cards. Such information is essential to helping parents understand what is happening in schools and for helping community partners identify schools in need of their resources.

7. Promote the reporting of chronic absence by grade level. Such data are critical to targeting interventions to the students who are struggling the most. Without grade level breakouts, school districts can easily overlook high levels of chronic absence starting in kindergarten and first grade. Chronic absence is typically highest in these early elementary grades, which are so critical to the development of key academic and social skills needed to succeed in school. Such patterns are easily masked when examining data for an entire elementary school, since children in the older grades typically have much better attendance.

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