New York State Health Education

Lacking State Funding, Rural Schools Struggle to Provide Remote Health Care

In rural school districts where doctors are hard to find, in-school telehealth services seemed like a good solution. Then New York state stopped funding them.

Bianca Fortis · June 5, 2024

A nurse stands at a computer in a school nurse's office

Kristin Fuller, RN, at a telehealth station in the Genesee Valley School District. | Bianca Fortis

Staying Focused

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The equipment was ready at the Randolph Central School District in western New York. Two mobile telehealth carts, one at the elementary school and one at the high school, stood prepped and available to help treat students. Each had a computer with a web camera, a stethoscope, a blood pressure cuff, and an electrocardiogram machine, among other diagnostic tools. They’d need a nurse physically present to connect to a remote physician, who would assess students in real time.

To Kaine Kelly, the schools’ superintendent, the mobile clinics seemed like a promising way to provide medical care to kids in the area. Near the state’s southwest corner, the Randolph Central School District spans 254 square miles and has few local doctors. Students’ visits would be billed through the parents’ insurance, and the state would reimburse two-thirds of the yearly $16,000 operating cost. Randolph had hired an additional nurse to its staff, and there was a possibility of offering remote therapy visits, an appealing option with post-pandemic mental health problems on the rise.

“We were ready,” Kelly said. “We were all planned out, ready to roll and we were very, very excited. Our Board of Education was very excited. Our principals were excited about being able to provide this service to our kids.”

“We were ready. Our principals were excited to provide this service to our kids.”

—Kaine Kelly, Randolph Central School District

In 2021, just as the district was ready to start using the equipment, Kelly learned that the New York State Education Department would no longer reimburse the cost of telehealth services. A bill now pending in the state legislature would change that, but its sponsors say it won’t make it through before the session ends on Thursday. Unable to afford the costs on its own, the district has left the mobile telehealth stations sitting unused.

“We’re currently just sitting in a holding pattern, unable to provide these services to our community,” Kelly said.

State support for school-based telehealth services had been in place since 2017, when the legislature amended the state’s public health law to expand the list of places eligible to provide it. Then the legislature removed the relevant language during the 2021 state budget process — which, state Education Department officials say, renders the agency unable to authorize the reimbursement funds.

According to Assemblymember Amy Paulin, that was never the intent of the change. She and Senator Shelly Mayer have been pushing to reestablish telehealth services in schools via the education law, this time by adding them to the list of school-based health services available to students. But as of last week, the legislation had been pushed back to next session. Paulin said the education and health departments need more time to resolve regulatory questions before the legislature can vote on the bill.

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Adding the telehealth clinics would allow Randolph to contract with Mobile Primary Care, the same Buffalo-based provider that other districts have used to operate the telehealth clinics, and file the expense through its local Board of Cooperative Educational Services, a type of network that allows small districts to share expenses.

In Randolph, administrators hoped that the clinic would help reduce rates of absenteeism, which skyrocketed during the Covid pandemic. Students could see a doctor from school, Kelly figured, and parents wouldn’t have to miss work to drive their sick kid to a doctor. And students struggling with their mental health following the pandemic could be offered more support.

“It almost felt like the rug was pulled out from underneath us,” said Charles Shevlin, the district’s business administrator. “Given the climate coming out of a pandemic, everything kind of made sense. And we thought, of course, this is going to work out.”

A truck driving down a rural road through the woods. In the foreground, a yellow sign reads "SCHOOL BUS STOP AHEAD 500 FEET"

A road approaches a school bus stop in Allegany County. | Bianca Fortis

About an hour east, in Allegany County, the Genesee Valley School District had already implemented its telehealth services from Mobile Primary Care. After the state stopped offering reimbursements, Genesee Valley paid for them out of pocket for the next three years. There was a high need, said superintendent Brian Schmitt, in the district of about 600 students, more than half of whom receive free and reduced lunch. Nearly a quarter of school-aged children in the district live under the poverty line, according to 2022 census data.

“One of our main goals was just to alleviate stress for parents,” Schmitt said.

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Mark Wolbert, the vice president of telemedicine at Mobile Primary Care, said the company also works with the Cattaraugus-Little Valley Central School District and the Saranac Lake Central District. Other districts cut the service after the state removed the reimbursement option. With just a few districts using the service, there were 278 student patient visits during the 2023–24 school year. Wolbert said he had conversations with dozens of districts across New York, including on Long Island, where administrators expressed interest in telehealth medicine before they lost the ability to use state aid.

“It’s not an onerous number, it’s a very manageable thing,” Wolbert said about the cost of the services. “However, it’s just another line item on their budget. They had support, and then they didn’t have support. So that’s a hard thing for a superintendent to swallow.”

John Sipple, a Cornell professor and researcher who studies the impact of school-based clinics in rural communities, said that while an in-person clinic might be preferred, technological advances have made telehealth services a viable option for understaffed rural school districts.

“One of our main goals was to alleviate stress for parents.”

—Brian Schmitt, Genesee Valley School District

“With proper equipment, you can actually provide pretty good basic primary care,” Sipple said about telehealth medical services. “And at the very least, you can triage to the point where you can determine via telehealth which child really needs to be put in a car or put in an ambulance and be sent to an actual health care provider and which are seen just fine remotely.”

At its peak, during the 2021–22 school year, the Genesee Valley School District had 42 telehealth visits. The number of visits has dwindled since the county health department provided the district with an Abbott testing machine capable of quickly running a number of diagnostic tests, including for COVID-19 and the flu. But those machines aren’t widely available in most districts.

Because the telehealth station isn’t being used as often, Genesee Valley has recently ended its contract with Mobile Primary Care. But Schmitt said that if the district could receive the reimbursement, he would reinstate the service to provide both medical and mental health care. The company does offer a mental health component, but has had difficulty in keeping mental health providers on, Wolbert said.

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In the wake of the pandemic, teenagers’ mental health has become an increasingly pressing concern. In 2021, 33 percent of New York high school students reported persistent feelings of being sad or hopeless, according to the federal Youth Risk Behavior Surveillance System. Nearly 17 percent of New York high schoolers that year said that they had seriously considered attempting suicide.

Even much larger districts see value in telehealth mental health services. Last fall, New York City announced a $26 million contract with Talkspace, a provider that connects users with remote mental health professionals, to city residents between the ages 13 and 17. With a nearly $40 billion budget, the city can afford the expense. Most rural districts can’t — and they often can’t get mental health providers to come to remote areas in person, either.

“In most areas, if you deny tele-mental health services to students, that simply means it’s more expensive for the school district,” David Little, the executive director of the Rural Schools Association, said. “In rural areas, denying tele-mental health services to students is to deny them the service that they need altogether — because they can’t get them otherwise.”