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Early School Medicaid Expansions and Health Services for Children with Parental Opioid Use Disorder

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Title: Early School Medicaid Expansions and Health Services for Children with Parental Opioid Use Disorder
Language: English
Authors: Angélica Meinhofer, Lindsey Rose Bullinger, Caroline Hope Kelly, Maria Fitzpatrick
Source: Grantee Submission. 2025 6(6).
Peer Reviewed: Y
Page Count: 11
Publication Date: 2025
Sponsoring Agency: National Institute on Drug Abuse (NIDA) (DHHS/PHS)
Contract Number: K01DA051777
Document Type: Journal Articles
Reports - Research
Education Level: Elementary Secondary Education
Early Childhood Education
Preschool Education
Descriptors: Health Insurance, Narcotics, Drug Addiction, Access to Health Care, Parent Child Relationship, Federal Programs, Transportation, Costs, Barriers, At Risk Persons, Physical Health, Mental Health, School Health Services, Eligibility, Financial Support, Elementary Secondary Education, Preschool Education, Comparative Analysis, Prevention, Primary Health Care, Dental Health, Rehabilitation, Hospitals, School Nurses, Screening Tests, Diagnostic Tests, Therapy, State Programs
DOI: 10.1001/jamahealthforum.2025.1288
Abstract: Importance: Children experiencing parental opioid use disorder are a growing population at heightened risk of physical and mental health issues over the life course. Yet these children are less likely to receive comprehensive, ongoing health care and their parents are more likely to report barriers to access health care for their children. School-based health services have potential to overcome some of these health care access barriers, including parental burden, transportation, time, costs, and health care discontinuity. In 2014, Medicaid revoked its longstanding free care rule, expanding the scope of school-based health services eligible for Medicaid reimbursement. Subsequently, some states began to expand their school Medicaid programs to benefit from the new federal rule. Objective: To estimate the early effects of state school Medicaid expansions on the receipt of Medicaid-funded school-based health services among children who have experienced parental opioid use disorder. Design, Setting, and Participants: This cohort study using nationwide Medicaid claims data included Medicaid-enrolled children aged 5 to 18 years who experienced parental opioid use disorder at any point before age 19 years. A difference-in-differences design that exploits the staggered implementation of school Medicaid expansions between 2014 and 2019 was used. Data were analyzed between January 2023 and January 2025. Exposures: Children living in states implementing (treatment group) and not implementing (comparison group) school Medicaid expansions, before and after state-specific expansion dates. Main Outcomes and Measures: Binary measures indicating receipt of school-based health services, primary care, prevention, rehabilitative, dental, and mental health services, emergency department visits, and inpatient hospital stays. Results: The sample comprised 6?628?404 person-years from 1?700?304 children. The mean (SD) age was 10.5 (3.9) years and 3?371?918 (51%) were male. School Medicaid expansions increased the receipt of Medicaid-funded school-based health services by 8.9 percentage points (pp; P = 0.01). Growth was primarily driven by school claims for nursing services (difference, 7.4 pp; P = 0.02) and for Early and Periodic Screening, Diagnostic and Treatment services (difference, 8.6 pp; P = 0.04). Reductions in emergency department visits among children aged 5 to 11 years were also documented (difference, -1.8 pp; P = 0.02). Conclusions and Relevance: This cohort study found that, given the complex health and health care needs of children growing up amid the opioid crisis, integrating health care into schools may offer a promising policy solution.
Abstractor: As Provided
Entry Date: 2025
Accession Number: ED673670
Database: ERIC
FullText Text:
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  Data: Early School Medicaid Expansions and Health Services for Children with Parental Opioid Use Disorder
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  Data: <searchLink fieldCode="AR" term="%22Angélica+Meinhofer%22">Angélica Meinhofer</searchLink><br /><searchLink fieldCode="AR" term="%22Lindsey+Rose+Bullinger%22">Lindsey Rose Bullinger</searchLink><br /><searchLink fieldCode="AR" term="%22Caroline+Hope+Kelly%22">Caroline Hope Kelly</searchLink><br /><searchLink fieldCode="AR" term="%22Maria+Fitzpatrick%22">Maria Fitzpatrick</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Grantee+Submission%22"><i>Grantee Submission</i></searchLink>. 2025 6(6).
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  Data: 11
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  Data: 2025
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  Label: Sponsoring Agency
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  Data: National Institute on Drug Abuse (NIDA) (DHHS/PHS)
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  Data: K01DA051777
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Preschool+Education%22">Preschool Education</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Health+Insurance%22">Health Insurance</searchLink><br /><searchLink fieldCode="DE" term="%22Narcotics%22">Narcotics</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Addiction%22">Drug Addiction</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Federal+Programs%22">Federal Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Transportation%22">Transportation</searchLink><br /><searchLink fieldCode="DE" term="%22Costs%22">Costs</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Health%22">Physical Health</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22School+Health+Services%22">School Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Eligibility%22">Eligibility</searchLink><br /><searchLink fieldCode="DE" term="%22Financial+Support%22">Financial Support</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Education%22">Preschool Education</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+Analysis%22">Comparative Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Primary+Health+Care%22">Primary Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Dental+Health%22">Dental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Rehabilitation%22">Rehabilitation</searchLink><br /><searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22School+Nurses%22">School Nurses</searchLink><br /><searchLink fieldCode="DE" term="%22Screening+Tests%22">Screening Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnostic+Tests%22">Diagnostic Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Therapy%22">Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22State+Programs%22">State Programs</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1001/jamahealthforum.2025.1288
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Importance: Children experiencing parental opioid use disorder are a growing population at heightened risk of physical and mental health issues over the life course. Yet these children are less likely to receive comprehensive, ongoing health care and their parents are more likely to report barriers to access health care for their children. School-based health services have potential to overcome some of these health care access barriers, including parental burden, transportation, time, costs, and health care discontinuity. In 2014, Medicaid revoked its longstanding free care rule, expanding the scope of school-based health services eligible for Medicaid reimbursement. Subsequently, some states began to expand their school Medicaid programs to benefit from the new federal rule. Objective: To estimate the early effects of state school Medicaid expansions on the receipt of Medicaid-funded school-based health services among children who have experienced parental opioid use disorder. Design, Setting, and Participants: This cohort study using nationwide Medicaid claims data included Medicaid-enrolled children aged 5 to 18 years who experienced parental opioid use disorder at any point before age 19 years. A difference-in-differences design that exploits the staggered implementation of school Medicaid expansions between 2014 and 2019 was used. Data were analyzed between January 2023 and January 2025. Exposures: Children living in states implementing (treatment group) and not implementing (comparison group) school Medicaid expansions, before and after state-specific expansion dates. Main Outcomes and Measures: Binary measures indicating receipt of school-based health services, primary care, prevention, rehabilitative, dental, and mental health services, emergency department visits, and inpatient hospital stays. Results: The sample comprised 6?628?404 person-years from 1?700?304 children. The mean (SD) age was 10.5 (3.9) years and 3?371?918 (51%) were male. School Medicaid expansions increased the receipt of Medicaid-funded school-based health services by 8.9 percentage points (pp; P = 0.01). Growth was primarily driven by school claims for nursing services (difference, 7.4 pp; P = 0.02) and for Early and Periodic Screening, Diagnostic and Treatment services (difference, 8.6 pp; P = 0.04). Reductions in emergency department visits among children aged 5 to 11 years were also documented (difference, -1.8 pp; P = 0.02). Conclusions and Relevance: This cohort study found that, given the complex health and health care needs of children growing up amid the opioid crisis, integrating health care into schools may offer a promising policy solution.
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PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=ED673670
RecordInfo BibRecord:
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        Value: 10.1001/jamahealthforum.2025.1288
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
    Subjects:
      – SubjectFull: Health Insurance
        Type: general
      – SubjectFull: Narcotics
        Type: general
      – SubjectFull: Drug Addiction
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      – SubjectFull: Access to Health Care
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      – SubjectFull: Parent Child Relationship
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      – SubjectFull: At Risk Persons
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      – SubjectFull: Physical Health
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      – SubjectFull: Mental Health
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      – SubjectFull: School Health Services
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      – SubjectFull: Elementary Secondary Education
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      – SubjectFull: Preschool Education
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      – SubjectFull: Prevention
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      – TitleFull: Early School Medicaid Expansions and Health Services for Children with Parental Opioid Use Disorder
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