Access to health care services in rural or other underserved communities across Ohio has long been a priority for both health care providers and for local community leaders. Some communities have solved the gap in service by building creative collaborations among local school districts, health care providers and other service partners to prop up school-based and mobile health clinics. 

School districts already provide a certain level of health care services to students. However, the needs of students and their families are often complex and exceed what the traditional school nurses’ office can provide. When additional resources are not readily available outside of the school setting, students suffer. As a result, school districts in underserved areas are often eager to improve the health care delivery modes to their students. Indeed, the state of Ohio has prioritized and devoted funding and other resources to helping school districts solve for the lack of health care access. In turn, local school districts are deploying grant funding and other public funding resources to improve access to local health care.

Collaborations between school districts and providers take many forms. A school district may contribute space in existing school facilities to a health care provider in exchange for a commitment by the provider to operate an on-site community health center. These on-site or school-based health centers provide convenient services to the school district’s own students, but also to the families and community at large. 

Other models for collaboration utilize a management agreement structure pursuant to which the health care provider commits to manage the on-site or school based health clinic, lending oversight of health care providers and facilitating special programs that aim to improve the health outcomes of the community. Through this structure, the school district contributes facilities and other operating costs associated with the services. 

In some cases, the collaborations are broader and include other service providers and recreational/wellness facilities in addition to dedicated health center space. For example, a health center on school property may be co-located with office space used by social service agencies, a fitness center and county services. What can emerge is a magnetic hub where residents come for a variety of purposes, strengthening the already central role occupied by the local school district. 

Care is required in structuring contractual arrangements with a public school district. As a public entity, school districts must have clear statutory authority in order to undertake various projects. For example, school districts must make annual appropriations with respect to expenditures, so structuring certain longer term arrangements must accommodate such requirements. Where school facilities have been financed with tax-exempt obligations, compliance with applicable Internal Revenue Code and related regulations will impact how the contractual arrangements are structured. 

School-based collaborations often begin with a Memorandum of Understanding (MOU) in order to outline key terms and allow the parties to pursue due diligence and grant funding opportunities. The MOU also can outline early on, the respective obligations of the school district and the provider in terms of HIPAA and FERPA compliance.

Once due diligence, funding and other permits and approvals are obtained or in process, the collaboration can be documented in operative documents. Depending on the structure of the deal, these documents may take the form of a lease agreement, a management agreement, a joint operating agreement or services agreement. 

Like school-based health clinics, mobile clinics are increasingly being deployed by various providers, including managed care companies, to deliver health clinic care to underserved populations in a more cost-effective manner. An example is a mobile asthma care vehicle that visits schools within a region on recurring schedule in order to help students manage asthma. School districts participate in these collaborations through supplemental funding or through assistance in accessing grant funding sources.

The pandemic has amplified the degree to which some underserved communities suffer, and Ohio’s public school systems in these areas have more acutely felt the impact on their students and families during the past year. Where health care can be conveniently accessed, student outcomes are improved. Creative collaborations designed to cost effectively solve for the gap in local care is proving to be an answer for some Ohio school districts and health care providers around the state. 

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