Why a North Texas suburban school district is opening a new health clinic for students on Medicaid

Subscribe to The Y’all — a weekly dispatch about the people, places and policies defining Texas, produced by Texas Tribune journalists living in communities across the state.

---

DENTON— A North Texas school district plans to open a new school-based health clinic to serve its students covered by Medicaid, despite concerns from certain parents that the district is overstepping its role.

Leaders in the Denton Independent School District say the clinic will make health care more readily available for its students — 49% of whom are eligible for the federal free or reduced price lunch program, an indicator of economic hardship.

In August, the school board approved a partnership with North Texas nonprofit PediPlace to construct a medical clinic inside one of its high schools. The clinic, which is set to open in January, will be the second of its kind in Denton County, one of the fastest-growing counties in the state.

PediPlace operates the other clinic in the county out of a high school in the neighboring Lewisville Independent School District. Both clinics provide preventive care, vaccinations and mental health screening and counseling.

Over five million children in Texas are on Medicaid, CHIP or are uninsured, making access to reliable health care difficult and time-consuming. Texas has made improvements over the past several years as the number of uninsured people has decreased. And, the state is still second in child Medicaid and CHIP enrollment.

Because underinsured children struggle to obtain treatment, the gap in care leaves school nurses in a constant battle to support students’ health, says Denton ISD Director of Health Services Nicole Goodman.

“We may be able to get them in to get that one problem solved, but we don't have somewhere to send them long-term,” Goodman said.

The clinic will be built at Fred Moore High School, an early graduation high school with a small class size of 56 students. All 30,000 students enrolled in the district, regardless of which school they attend will be able to use the clinic as long as they are on Medicaid.

The new clinic opens as certain families in Texas are becoming more concerned with the role schools play in their children's lives. School board meetings addressing the partnership were met with constant public comments from parents concerned about what one parent described as “undermining parental authority.” Multiple parents described the clinic as a “Pandora’s Box” to more clinics in schools or district overreach.

“Grooming and indoctrination of children will more easily happen if you decide to treat children on campus,” Denton resident Mary Knox said during Denton school board’s Aug. 22 meeting.

Critics of the clinic worry students would access care without parental consent, especially mental health services or gender-affirming care. In reality, parents must accompany children in order for them to receive care at PediPlace, and the clinic does not offer any kind of gender-affirming care.

Denton ISD’s board of trustees ultimately approved the creation of the clinic, 6-1. Board member Amy Bundgus was the lone no vote.

While Denton ISD’s clinic was approved, other districts in the state have also experienced the brunt of parents’ rights advocates. The Humble Independent School District in Houston initially halted plans to build a clinic in one of its high schools due to concerns about gender-affirming care and birth control access. It’s moving forward after a 5-2 vote from Humble ISD’s school board.

There are almost 90 school-based health centers in Texas, almost all of them are concentrated in urban areas like Dallas, Fort Worth and Houston. Fewer still are geared solely toward students on Medicaid or CHIP.

The Texas Department of State Health Services funded a small number of school-based clinics across the state until 2021, when state agencies were asked to reduce their budget.

For lower-income family members unable to afford to take days off for doctor visits, school is often their first stop when a child needs to be treated.

“Children would show up early to school to essentially be triaged by the school nurse so their parents could determine, did the child have to go to the doctor?” said Larry Robins, PediPlace’s president and chief executive officer.

In the past decade, the number of health providers who accept Medicaid in Denton County has fallen, from 320 to 183, according to the United Way of Denton County. Dr. Marquis Nuby, a Denton pediatrician who accepts Medicaid, the federal health insurance plan for low income Americans, says finding a doctor who accepts Medicaid can be a daunting task. Many health care professionals in Texas have refused to accept Medicaid because of its low reimbursement rate.

“There’s kids that will come for my practice that may come from Mesquite, may come from Garland, may come from Wise county, may come from Fort Worth,” Nuby said. “They come out here, because they’re struggling to find a spot.”

And amid a growing national mental health crisis, Nuby said access to mental health treatment is crucial, especially for children.

“Since COVID, it became a tsunami,” Nuby said. “Every time I see someone for mental health, I’m losing money.”

Most school-based health centers are funded by nonprofits or other organizations, like Denton ISD’s partnership with PediPlace. Robins said that despite the “very different communal response” the proposed clinic received compared to PediPlace’s first clinic in Lewisville ISD, he feels community support is stronger than ever.

“I don't believe that communities would be increasing funding if they weren't wholeheartedly supportive investors in our mission and in the quality work that we provide,” Robins said.