Expanding school-based telehealth services can increase access to health services for children and youth and ultimately improve health and social outcomes. In general, school-based health services are an effective, cost-efficient strategy for enhancing timely access to care by serving children where they spend most of their time. However, barriers such as funding and workforce shortages can limit availability of these services.
Telehealth may help overcome these barriers by providing efficient models of care and augmenting the capacity of local providers. Telehealth encompasses a broad range of technologies that support remote health care and health-related services and has been shown to be comparable to in-person care for a wide range of conditions for children.
School-based telehealth may have particular potential in rural areas, where provider shortages and long travel times limit access to health services. For example, rural schools are less likely than urban schools to have school-based health centers. Expanding school-based telehealth is one strategy to address these challenges in rural communities by allowing students to access health care services remotely through their schools.
What Do Care Models for School-Based Telehealth Look Like?
School-based telehealth has been used to support a wide variety of services for children and youth, including:
Frequently, school-based telehealth programs are part of broader school-based health centers and led by sponsoring health centers or health systems. As of 2024–2025, an estimated 22 percent of public schools offered mental health services through telehealth. Earlier evidence suggests that telehealth was already common among school-based health centers: a 2022 survey found that most such centers offered telehealth for primary care and/or behavioral health services.
While there are numerous ways telehealth can support children and youth, a common model is direct care to children and/or families through videoconferencing. Under this model, school staff, such as a school nurse or medical aide, support set up of video conference appointments within schools and allow students/families to connect with offsite providers. Depending on the telehealth program and workflow, caregivers may or may not join a telehealth visit along with the child. School and health care providers implementing direct care through telehealth must consider workflows and policies related to obtaining caregiver consent for telehealth visits, maintaining student privacy/confidentiality, processes for scheduling telehealth visits, coordinating care with caregivers and other providers following telehealth visits, and billing for telehealth services.
Telehealth can also support access to care in other ways, such as training of school staff and provider-to-provider consultation to expand capacity of school health providers. For example, schools have used the Project ECHO model to provide training and education to school-based behavioral health providers, including school social workers, psychologists, and case managers.
What is the Medicaid Policy and Funding Landscape for School-Based Telehealth?
Telehealth services are frequently supported by public dollars, including grants or direct billing for services. Medicaid reimbursement plays an important role in supporting the sustainability of school-based health services, including telehealth. Both Medicaid telehealth reimbursement policies and broader school-based health policies impact school-based telehealth coverage. Until 2014, Medicaid could only cover school-based services outlined in individualized education programs (IEPs) for children and youth with disabilities. States now have broad flexibility to cover Medicaid services in school-based settings, though expansion of school-based service coverage varies by state. Broadening coverage of school-based services, regardless of mode of delivery, is one strategy for supporting broader use of school-based telehealth.
States may also consider opportunities to expand telehealth service coverage. State coverage of telehealth services, including for school-based programs, expanded during COVID-19 and most states cover a range of telehealth modalities. However, variability exists across states regarding what services are covered, payment levels (e.g., payment parity), and billing policies. States may consider opportunities to address gaps in telehealth coverage for children and youth as well as provide clear billing guidance to support schools and telehealth vendors in implementing school-based telehealth programs.
In addition to ongoing telehealth sustainability, start-up costs, staff training, workflow development, and aligning priorities across organizations (e.g., school and provider organizations) can be challenging for program implementation. States may consider how to support infrastructure costs such as through grants or funding state telehealth programs. States may also consider how to leverage their convening role to promote coordination across agencies or provider organizations as well as support training and technical assistance for school telehealth programs. Rural Health Transformation Program (RHTP) funding may provide opportunities since many state RHTP applications focused on telehealth and/or school-based health services.
What is the Evidence for School-Based Telehealth?
Studies suggest school-based telehealth: is associated with strong patient and family satisfaction; supports positive health outcomes and/or is equivalent to standard care for a range of conditions; and may reduce school absences. Further research is needed to continue building the evidence base for school-based telehealth as well as to understand implementation barriers and facilitators.
- Systematic Review of School Telehealth Evaluations: In this review of 20 studies from 2006-2018, some evidence of health improvement or equivalence to usual care was found for children with asthma, diabetes, and speech impairments. There is also evidence that school-based telehealth is associated with reduced emergency department utilization, though findings varied across relevant studies. Further research is needed on factors influencing telehealth program implementation.
- School-Based Tele-Behavioral Health: A Scoping Review of the Literature: A review of 18 studies found that eight included qualitative or quantitative intervention outcomes. The review found high levels of patient and family satisfaction with telehealth and some evidence of improved behavioral health outcomes. One study found evidence of more timely access to care.
- Effectiveness and Cost-Benefit of an Elementary School-Based Telehealth Program: This quasi-experimental study evaluated telehealth impact at six elementary schools from 2015-2017 and found that the intervention was associated with a 7.7 percent decrease in school absences. The study also included a cost-benefit analysis finding that society-wide benefits outweighed program costs.
- Telemedicine Referral to Improve Access to Specialty Care for Preschool Children in Rural Alaska: A Cluster-Randomized Controlled Trial: This study examined telehealth’s role in enabling timely access to care following preschool hearing screenings in rural communities. Referral of children to specialty telemedicine, based in a community clinic, was compared to standard primary care referrals following preschool screenings. The specialty telemedicine referral was associated with increased follow-up rates for referred children and reduced time to follow up.
What do School-Based Telehealth Models Look Like in Practice?
The following resources offer insight into how organizations implement or support school-based telehealth:
