During the 2024-2025 academic year, children at New York’s P.S 5 collectively visited its school-based health center (SBHC) a total of 3,335 times. According to the Center’s staff, some of the Title 1 school’s approximately 400 low-income students came in for daily insulin injections or to take prescribed medications for chronic health conditions. Others were there due to an injury, or because they had a sore throat, runny nose, or upset stomach. Still others visited the center for on-site dental care or to talk about something that was bothering them.
P.S. 5’s SBHC is run by Children’s Aid (formerly the Children’s Aid Society), a nonprofit that has worked since 1853 to eradicate poverty and promote child welfare. The organization currently runs six SBHCs in underserved areas of New York City and, depending on the host school, provides care to kids from age three to age twenty-two. Families do not pay out-of-pocket for the services their kids receive. Instead, a patchwork of federal Medicaid dollars, state funding, and donations to Children’s Aid keeps the clinics afloat.
But pending cutbacks to the Medicaid program have put the future of school-based health centers—a nationwide network of approximately 4,000 clinics—in jeopardy. As advocates at the Healthy Schools Campaign warn, “Cuts in Medicaid will require districts to divert funds from other educational programs.”
And it’s not just SBHCs that are at risk. Medicaid and the Children’s Health Insurance Program (CHIP) currently provide coverage to 37 million children under the age of nineteen. Moreover, since 2014, schools have been able to bill Medicaid for therapeutic services such as speech, occupational, and physical therapy, as well as assistive technologies for children who are Medicaid recipients.
This, in addition to reimbursement for medical care provided by a school nurse, has allowed schools—even those without a school-based health center—to receive federal dollars to ensure that student medical needs are met. The loss of this revenue, advocates say, will be catastrophic.
Currently, SBHCs address needs that are common in school communities. A March 2025 report from the Healthy Schools Campaign, the National Association of School Superintendents, and the Association of School Business Officials notes that 20 percent of children under eighteen have a physical or mental health issue, including anxiety, developmental delays, asthma, attention-deficit hyperactivity disorder, diabetes, or vision impairments.
Predictably, the impact of the impending funding cuts will fall most heavily on those who are least able to afford it, with low-income children of color bearing the brunt of fiscal retrenchment. The result, education activists say, will be increased absenteeism, higher dropout rates, and reduced school completion—preventable outcomes that can be mitigated by school staff and SBHCs.
Robert Boyd, president and CEO of the School-Based Health Alliance, notes in an interview with The Progressive that while SBHCs are relatively rare—only about four percent of the country’s nearly 100,000 public schools have them—their success rate in reducing health disparities between low-income and richer students has been widely recognized.
By improving access to behavioral, medical, and psychological care, Boyd says, the centers have made a dent in reducing health inequities between low-income students and their middle- and upper-class peers.
But even among SBHCs, Boyd notes, there is wide variation in where and how services are provided. Some SBHCs, like the one at P.S. 5, are located on school premises, while other communities have set up off-site clinics that are in close proximity to a host school. Mobile units and telehealth have also been effectively utilized, especially in rural areas. In addition, the services offered can also vary, with some providing only basic care and routine physical examinations, and others offering comprehensive dental, optical, reproductive, medical, and mental health services.
SBHC sponsorship also varies, with Boyd stressing that about two-thirds of school-based centers are run by Federally Qualified Health Centers (FQHCs)—government-funded, community-based, primary care clinics that offer a range of health care services to underserved populations. FQHCs, Boyd notes, are reimbursed by Medicaid at a higher rate than non-FQHCs or pediatricians.
But now, passage of the Trump Administration’s budget bill—and concomitant cuts to Medicaid and other safety net programs—will put states in a bind, with lawmakers having to decide between using general state revenue to continue funding school nurses and SBHCs, raising taxes, or reducing the type of care that is covered by Medicaid.
Colin Reusch, director of a health equity advocacy group called Community Catalyst, tells The Progressive that “many states stand to lose millions of dollars over the next ten years,” putting them in an increasingly precarious financial position. “This threatens school health care delivery and SBHCs,” he explains. “How each state will accommodate the Medicaid cuts, and determine how the cuts will impact eligibility and benefits for recipients, is yet to be seen, but early indications are that services like dental care will be cut.”
Reusch notes that these cuts can have “an outsized impact on underserved kids,” for whom school-based health care is often the only medical care available to them. “We know that between 70 and 80 percent of students who access care through an SBHC are Black, come from tribal communities, or are part of other communities of color.”
The looming cuts worry the staff at P.S. 5’s SBHC, who are nonetheless doing what they can to advocate for themselves and the students they serve.
“We’re doing a lot of advocacy at the state level,” Michelle Avila, director of public policy at Children’s Aid, tells The Progressive. “Right now we’re in limbo. The state of New York is unclear about how or if Medicaid cuts will be implemented. We know that SBHCs are a lifeline, and we’re bringing students, parents, and school staff to the state capital in Albany to make sure legislators understand what we do and how essential this care is for student well-being.”
Pediatrician Lauren Jen, assistant medical director at Children’s Aid, hammers the point. “SBHCs are already operating on a razor-thin margin,” she says. “The fact that we are now facing cuts means that some SBHCs will probably not make it. When kids have to go to an emergency room instead of seeking health care at school, those whose families are uninsured will end up with huge bills.”
“At P.S. 5, kids are seen by kind, competent adults who make sure they get the right treatment and care,” Jen continues. “This makes it possible for the kids to stay in school and learn, and makes it possible for their parents to stay at work. It also promotes a sense of community belonging.”
For a moment, Jen sounds frustrated, but quickly shifts gears to stress how much she and her colleagues love what they do. “This is truly joyful work,” she says. “Being the helpful adults in children’s lives is wonderful.”