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School & Health: Our Nation's Investment
family planning, and Early and Periodic Screening, Diagnostic, and Treatment services for children under age 21. The EPSDT component of Medicaid was originally designed to provide comprehensive health screening for poor children, as well as subsequent diagnosis and treatment services for conditions found during the screening exams. Comprehensive screening included not only basic health, vision, hearing, and dental components but "anticipatory guidance" that could include counseling services, case management, and health prevention. Although federal law mandated EPSDT services for Medicaid-eligible children and adolescents, states have not provided sufficient outreach and follow-up to ensure that those eligible are actually screened.
The potential of EPSDT as a funding source for school-based services is ambiguous. Currently, Medicaid enrollees are being required to obtain coverage through managed care. Many HMOs and other managed care providers may not include preventive services, mental health services, and health screening as part of the package. In some places, school health service providers may have to negotiate with multiple plans for students in their schools. As Brindis (1995) points out, there are "conflicting priorities of SBHCs which seek to increase access to care and … managed care programs which must find ways to contain costs." Many other barriers stand between SBHCs and this form of health financing, not the least of which is the assurance of confidentiality. One proposal has been to create "school health resource partnerships" between districts, health providers, and other community agencies to address the financial viability of school health service programs in a managed care environment (Brellochs, 1995). States would require that managed care plans participate as a condition of licensure.
The recent revision of Chapter 1 will make it possible for schools to use some of the funds for social services in partnerships with community agencies. The various crime bills called for many millions for Beacon-type programs, but those funds have disappeared. Finally, the Division of Adolescent and School Health (DASH) at the Centers for Disease Control Prevention (CDC) is supporting many state and local HIV prevention initiatives, and recently began funding 12 states to strengthen their offices of health and education to provide more comprehensive schools health services and health education.
In some states, including Florida, California, and Kentucky, competitive grants have been awarded to school districts that must then seek partners in collaboration. In other states, such as New Jersey, a community-based agency may be the lead grantee and seek partnerships with a school. More than $30 million is being spent each year in Florida on the state's innovative full-service schools program, supporting collaborative school-based projects of varying service mixes, including family resource