Improving Governance to Reduce Administrative Burden and Increase Funding for School-Based Health Services

Public schools are critical sites to address children’s emergent health needs, yet they face ongoing challenges to finance and sustain health initiatives. Medicaid is an important funding source for school-based health services, accounting for over $8 billion in revenue for school-based health services in 2024 (Furtado et al., Citation2026), but it is underutilized. Drawing on interviews with state Medicaid and local educational agency personnel, this study illuminates administrative burdens in school Medicaid billing and the collaborative governance arrangements developed among states, localities, and third-party organizations to ease burdens. We find that cooperation between educational service agencies and school districts increased billing capacity and shifted administrative burdens up to higher-level educational units better equipped to manage them. Adopting collaborative governance models that leverage the comparative strengths and scaling capacities of public and private organizations may lessen administrative burdens and increase school Medicaid billing, although low Medicaid reimbursement remains a significant disincentive.