Federal Budget Proposal Threatens Key Supports for School Nursing

The proposed FY 2026 federal budget—unveiled by the Trump administration and supported by a House reconciliation package—signals steep cuts to public health and education spending that would have serious implications for school nurses and the students they serve.

What's at Risk?

The budget blueprint slashes non-defense discretionary spending by over $160 billion, while boosting military and border security funding. If enacted as proposed, the cuts would significantly weaken the infrastructure that supports school nursing:

Public Health Programs: Deep cuts to the CDC and Health Resources and Services Administration (HRSA) jeopardize funding for school-based health initiatives, immunization tracking, and chronic disease prevention.

Medicaid Access: Proposed eligibility restrictions and work requirements would reduce Medicaid enrollment among students. Fewer children covered means reduced access to care—and less Medicaid reimbursement for school health services.

Medicaid Matters

Welcome to Medicaid Matters, a series of short videos from the National Association of School Nurses. In each episode, you'll hear directly from school nurses about how Medicaid funding supports student health — and what's at stake if proposed cuts move forward. 

Watch more of these short videos on our YouTube playlist and subscribe so you won't miss when new ones are added.

Check out more information on Medicaid.

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Education Funding: Decreases in Title I and IDEA funding leave schools with fewer resources to support student health and wellness—threatening the hiring and retention of school nurses.

Health Equity: Reduced support for rural health, mental health, and maternal-child health disproportionately harms underserved communities, increasing the demand on school nurses without increasing resources.

Why it Matters

School nurses are frontline public health providers. This budget undermines their ability to:

• Support students with chronic conditions and disabilities,
• Address absenteeism and behavioral health needs,
• Deliver preventive services and manage outbreaks,
• Sustain roles funded through Medicaid or public health grants.

What Can You Do

Our students can’t learn if they aren’t well—and school nurses can’t protect their health without federal support. NASN remains committed to ensuring your voice is heard in Washington.

NASN is actively monitoring developments and engaging partners across education and health sectors. School nurses can:

• Share stories about how federal funding supports your work,
• Contact your members of Congress to advocate for sustained investment in school health through the NASN Advocacy Action Center.
• Stay informed through NASN’s advocacy alerts and action center.

To date, only 25 states have taken steps to expand their school Medicaid program to cover services outside of an Individualized Education Plan (IEP), helping provide additional revenue and offsetting costs for services. Learn more about Medicaid and school nursing.

Colorado Epinephrine Legislation

The Colorado Association of School Nurses (CASN) successfully updated the undesignated stock epinephrine law to include alternate forms of epinephrine in SB25-278.

After the FDA approved Neffy 2 mg epinephrine nasal spray for emergency treatment of allergic reactions in children over 66 lbs on August 9, 2024. Subsequently, on March 5, 2025, the FDA approved Neffy 1mg for pediatric patients weighing between 33 and 66 pounds (15-30 kg). Unfortunately, the stock undesignated epinephrine law in Colorado only supported the use of auto-injectors. Colorado School Nurses requested intranasal and any additional forms of FDA-approved epinephrine included in the Undesignated Epinephrine Law. 

Acknowledging our members' requests, the CASN executive board contacted their paid lobbyist in February 2025 for assistance in updating the law to support all forms of FDA-approved epinephrine.  

In Colorado, the legislative session begins in January. By February, proposed bills were assigned, and the session was closed to the acceptance of any new bills. Fortunately, CASN already had several positive working relationships with members of the Senate and the House; and with negotiating and collaboration, a Senator and House Representative picked up our bill as a sponsor, and SB25-278 was added to the 2025 legislative session.

CASN was required to complete additional legwork. The co-chair of the advocacy committee contacted Neffy and the state pharmacy association, and both agreed that the bill would need to be updated in order for Neffy to be supplied as a stock, undesignated epinephrine in the schools. CASN nurses testified in the Committee and the House. With minimal change in the bill’s wording, SB25-278 passed unanimously through committee, appropriations, and both chambers, and was signed by the governor on May 30, 2025. 

OhioSEE

Ohio requires school-age children to undergo vision screenings; however, only 26% of students who require additional vision care, whether a comprehensive eye exam or glasses, actually receive it. Meanwhile, experts report that 80% of a child’s learning comes through sight. 

Therefore, the Ohio Student Eye Exam (OhioSEE) Program was proposed to provide comprehensive eye exams and glasses, as needed, to an estimated 33,000 children each year who fail vision screenings and do not have access to follow-up exams. The program is derived from the recommendations of the Children’s Vision Strike Force formed by Gov. Mike DeWine. The Governor’s proposed 2026-2027 executive budget recommends a total of $50 million over the biennium for the OhioSEE Program. The General Assembly will approve a final budget for the next biennium by July 1, 2025.

Administered by the Ohio Department of Health (ODH), the OhioSEE Program would benefit those in kindergarten through grade three, a critical time range for children learning to read. Children who fail a vision screening and do not receive follow-up eye care would be given a referral to be served through the program.

State-by-State Legislation

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