Chicago’s underutilized schools are an unrealized opportunity

In 2024–25, 40.1 percent of CPS students were chronically absent. That is the share who missed at least 10 percent of the year, roughly 17 school days, and it has held at 40 percent for three years while the statewide rate fell from a 2021–22 peak of 29.8 percent to 25.4. Among high schoolers the figure has stayed near 57 percent since the pandemic, up from about 37 percent before it. The district’s own guidance says that by ninth grade, attendance predicts whether a student graduates better than eighth-grade test scores do. A 40 percent chronic-absence rate is not a discipline problem or a motivation problem at that scale. It is a description of what it costs to get some Chicago children to a school building and keep them there.

Some of that cost is medical. In UChicago Medicine’s South Side service area, about 20 percent of children have asthma, against 10 percent in Illinois and 12 percent nationally; the medical center reports that Black children there go to the emergency department for it twice as often as other children, and by CDPH’s count six of the nine Chicago neighborhoods with the worst asthma outcomes are in that area. Emergency department visits for adolescent mental health conditions rose nationally during the pandemic and, among girls, stayed at or above 2019 levels into 2023, and the public option for a CPS student who needs counseling is one of the seven mental health clinics CDPH runs, the nearest of which is 2.1 miles from the median underutilized school.¹

Some of it is paperwork with teeth. Illinois requires a physical exam and current immunizations for students entering kindergarten or first grade, sixth grade, and ninth grade, and for every new enrollee, and lets a district exclude a student who has not produced the records by October 15. CPS’s 2025–26 notice to parents says a child without proof “will face exclusion from school.” Dental exams are due May 15 in kindergarten, second, sixth, and ninth grade; an eye exam is due at kindergarten entry or a first enrollment in Illinois, though a missing one cannot keep a child out. A family with a pediatrician handles this in an afternoon. A family without one has to find a provider who takes Medicaid, wait for an appointment, and lose an unpaid morning, in the first six weeks of school, or watch their child sent home in the seventh.

And some of it is fear. When federal immigration enforcement began operating in the city in 2025-09, CPS attendance fell from the first month of school to the second by 1.25 percentage points, more than double the normal seasonal drop, and 38 of the city’s 77 community areas, Belmont Cragin, Little Village, Pilsen, and Back of the Yards among them, fell further than the district as a whole. District officials said English learners were down 1.3 points over the first nine weeks, and Mather High School lost about four points in four weeks. The district told principals they could excuse those absences. Now, under H.R.1, the state has warned more than 700,000 Illinoisans that they are at risk of losing Medicaid, about half of them in Cook County, with work requirements and six-month redeterminations phasing in from 2027-01. The families least likely to have a doctor are about to have a harder time keeping the coverage that would pay for one.

The Community Preventive Services Task Force, an independent, nonfederal panel of prevention experts, supported by the CDC, that grades public health programs on the strength of their evidence, recommends school-based health centers in low-income communities. Its 2016 review of 46 studies, most of them in urban, low-income, majority-Black-and-Latino high schools, found that students at schools with a center earned higher grade-point averages, were promoted more often, were suspended less, and were less likely to drop out, alongside more vaccinations, less asthma morbidity, and fewer emergency department and hospital visits. The largest reductions in emergency use came at centers with the widest service range and the longest hours.

The mechanism is access. A 2023 study in JAMA Network Open compared counties before and after they gained a center between 1998 and 2017. Among children in low-income families, dental visits rose 6.4 percentage points, having a usual source of care rose 8.0, and insurance coverage rose 5.2, narrowing the gap with higher-income children on each. A national study using the same expansion found that adding a center’s worth of services cut the birth rate among 15-to-18-year-olds by 5 percent, with the largest effects among younger teens and among Black and Hispanic teens; the same authors found only small effects on dropout, which is worth saying plainly, because a center is not a graduation program.

On attendance the evidence is real and narrower than the enthusiastic version. The largest relevant study followed 14,030 students who used one of 17 clinics sponsored by federally qualified health centers in a large urban district between 2015 and 2020, against 230,046 who did not. Attendance improved after a student’s first visit, and the change was largest for students who came for mental health care: a trend that had been falling about a percentage point a month before the first visit rose about 1.4 points a month after it. The authors say the design cannot establish causation, and the reason is one any Chicago evaluation will inherit: students who use a center, and families who return the consent form, differ from those who do not before any care is delivered.²

Mental health is where the findings converge. When 14 Oregon schools with centers expanded their mental health services between 2013 and 2015, their students became less likely than students at every other school in the study to report a depressive episode, suicidal thoughts, or a suicide attempt, and the effect held against schools whose centers had not expanded. The softer benefits people who run these clinics describe first, an adult in the building who is not grading you, show up in the one large survey that looked for them only among the lowest-income students, which is to say among most of CPS. A primary-care and behavioral-health center, the tier Erie runs at most of its Chicago sites, is where the attendance evidence and the mental health evidence overlap, and it needs no dental operatory to build.

CPS’s 2025–26 space utilization file covers 510 school records and assigns a status to 496. It labels 266 underutilized. Its rows are schools rather than buildings — CPS scores co-located schools separately, so those 266 records stand in 265 buildings. At the district’s own assumptions of 28 students per elementary homeroom and 30 per high school homeroom, they hold about 101,800 empty seats, roughly 4,560 classrooms’ worth, and the district as a whole runs at 68 percent of its adjusted ideal capacity. About 91,300 students attend an underutilized building; about 81,700 of them attend one with no health center inside it. The buildings cluster where the need in the first section does: Austin has 16, South Lawndale 13, North Lawndale and West Town 12 each, Englewood 11, East Garfield Park and Roseland 10, New City, Auburn Gresham, and the Lower West Side nine apiece.

Thirty-three health centers operate in or beside a CPS school today, run by 13 sponsors: 11 community health centers, plus Rush and UI Health’s Mile Square. Thirty sit inside a school building. Of the 26 of those with a CPS space-use status, 19 are in a building the district calls underutilized: nearly three in four of the centers whose buildings CPS scores, and more than half of all 33. Existing centers already occupy slack space; the district did not plan that, and 246 underutilized buildings have no center.

One limit on the data. CPS calls a building underutilized when its enrollment is below 70 percent of its ideal capacity, and ideal capacity is a count of homerooms, so the label means surplus homerooms, not surplus square footage. It says nothing about plumbing, a separate entrance, ground-floor access, or ADA compliance, each of which decides whether a clinic can go into a given room, and three of the 265 buildings include leased classrooms a landlord would have to agree to. The map identifies buildings worth a site visit. It does not establish that any of them is ready.

Fifteen of the 33 centers are open to the community rather than to enrolled students only, so a parent, a younger sibling, or a neighbor can walk in, and three of those, Erie’s at Ward and at James Weldon Johnson and Alivio’s at Orozco, run five days a week at elementary schools of fewer than 300 students. Five already keep hours a working adult can use. Esperanza’s center at Marquette opens at 7:30, stays open to 6:30 on alternate Thursdays, and runs rotating Saturdays; its center at Noble Mansueto opens at 7:15, stays open to 6 on Tuesdays and Wednesdays, and opens Saturdays; Lawndale Christian’s at Farragut is open to 7 on Tuesdays; PCC’s at Steinmetz to 8 on Thursdays; Mile Square’s at Davis to 6 on Thursdays. For a family in the community areas above, those hours are the difference between an appointment and a missed one. The Community Guide review counted reduced parental productivity loss among a center’s measured effects, which is the economist’s way of saying a parent did not have to choose between a shift and a child’s asthma check.

A student’s health does not stop at the enrollment line. The parent with untreated depression, the older sibling who left school and has no doctor, the grandmother managing diabetes without a primary-care home are the household the student goes home to, which is why family health sits near the top of every list of reasons children miss school. A center with evening hours that treats the household treats the conditions the student carries in. The sponsors are community health centers built for exactly this: they see adults on a sliding scale regardless of insurance or immigration status, Alivio’s published fees for an uninsured visit start near $30, and the same behavioral-health clinician who sees a ninth grader at two o’clock can see the ninth grader’s mother at six. That is the reason the argument for these centers is not only academic. A center that changes a student’s grades is a good program; a center that changes the health of the house the student lives in changes the student’s life.

The other benefits compound. A center that immunizes a four-year-old sibling in June produces a kindergartner who is not excluded in October. Confidential adolescent care offered to a neighborhood’s teenagers, enrolled or not, reaches the young people the Oregon and national studies found benefit most. A building with a clinic in it is a building lit at seven in the evening, with a security officer at the door and someone at a front desk, on blocks where a lit public building is itself a service. And the trust runs back into the school. The family that gets its care at Ward or Orozco is a family that returns the consent form, comes to the conference, and calls the office instead of avoiding it, the kind of engagement the consent-return study found predicts attendance before any care is delivered.

This is what the district means, or should mean, when it says it wants schools to be community anchors. CPS’s community-schools model already treats the building as a neighborhood resource after hours; a health center is the version of that idea that pays for its own staff. A school that is where the neighborhood gets its shots, its counseling, its asthma plan, and its dental referral is a school the neighborhood has a stake in, and the buildings that become anchors are the ones any consolidation should build around rather than empty.

A center exists in a CPS building because of a license agreement, and it is worth knowing what one contains, because it is the whole of the district’s contribution. The instrument is a Law Department form. The Board’s rules let the Chief Operations Officer execute a real-property license of up to ten years without further approval from the General Counsel when the form is used unmodified except for its business terms, with the action reported to the Board afterward. The business terms are the ones that matter: the premises, described by rooms and square footage; the term in years and any renewal options; the rent, which for a sponsor is nominal, in the way the district has leased a closed school building to a charter operator for one dollar a year; and who pays for utilities, custodial service, and repairs. What the license does not do is fund anything. IDPH certifies the center under 77 Ill. Adm. Code 641. The sponsor adds the site to its federal scope of project so it can bill Medicaid at its prospective per-visit rate and buy drugs at 340B prices, and it hires the nurse practitioner, the behavioral-health clinician, and the medical assistant whose salaries make up most of a budget in the mid six figures. CPS’s consent packet decides which students can be seen.

On the district’s side the relationship sits in the Office of Student Health and Wellness, led by the Chief Health Officer, a position created in 2012 as a joint CPS–CDPH post. OSHW’s Student Health team manages the centers alongside the vision, hearing, and dental programs and the mobile providers CDPH contracts. The school nurses have reported through the special education office rather than OSHW, which means the nurse who knows which ninth graders still lack an October physical works for a different office than the team that licenses the clinic that could give it. That is a paperwork problem, and paperwork problems are the kind a district can fix without money.

The financing has to work without the district’s money, because the district does not have any to commit. The Board did not balance its FY2027 budget; it adopted one that assumes the $732.5 million gap away. The district’s 2026-07 proposal counted on a $200 million TIF surplus, a mid-year spending freeze, five furlough days, and the layoff of 760 teachers and 801 support staff. By the vote it had raised the TIF assumption to $285 million and dropped the furloughs, and the Board added a last-minute amendment assuming $150 million in state revenue the General Assembly has not appropriated, meant to head off the layoffs. That is what underfunding looks like from inside a district the state’s own evidence-based formula rates as short of adequacy: a budget balanced on money that may not come, and a landlord that cannot tell a sponsor what next year’s building budget will be. CPS cannot fund clinical operations and should not be asked to. What it can do is make the building a better deal: license terms long enough for a sponsor to amortize an exam-room build-out, utilities and custodial hours carried as the district’s in-kind share, and a space-utilization standard that counts a licensed clinic as used space instead of continuing to score the rooms as empty. Two centers closed on 2024-04-01, at Uplift and in the former Hope Institute building Rudolph now occupies, and a third, at Reavis, appears to have been consolidated before any of this year’s coverage cuts. The release rates that finding medium confidence, because it rests on the absence of a current listing rather than a closure notice, and leaves the row unresolved because the site’s old hours cannot be confirmed. Keeping the 33 that remain is the first job.

A clinic needs patients. A sponsor covers that mid-six-figure budget by billing per visit, and the building with the most empty rooms usually has the fewest students to bill for. Of the 265 underutilized buildings, 255 have at least six classrooms to spare, and their median enrollment is 305. Require six spare classrooms and at least 500 students, and 38 buildings qualify. At 400 students it is 72; at 600, 21. Illinois publishes no minimum enrollment for a certified center, so those thresholds are mine and can be moved.³ The shape survives wherever they sit: most buildings with room do not have the students.

The current roster shows what a center in a small school looks like. Rush’s center at Dunbar, a high school of 314 students, is open Tuesdays from 10 to 3. Friend Health’s at Beethoven, an elementary school of 293, opens Thursday and Friday. Tapestry 360’s at Gale, with 294 students, runs three days. The small-school centers open five full days are the ones that let the neighborhood in, Ward and Orozco among them, which is another way of saying they found their volume outside the enrollment. A student-only center in a small building gets a clinician one day a week, and a student who is sick on Wednesday gets a referral.

High schools are the sharpest version. CPS assigns a status to 79 high schools; 44 are underutilized. Their median enrollment is 356. Seventeen enroll fewer than 300 students, and 20 run below 30 percent of adjusted capacity. A high school of 200 in a building built for 1,200 cannot support a health center. It also cannot support a full course catalog, an AP sequence, a counselor with a manageable caseload, or a library that is open. The space problem and the program problem are the same problem with two names.

The empty seats are not scattered. The median underutilized building is four-tenths of a mile, about three blocks, from the next one. Across Austin, North Lawndale, and Englewood the pattern is two or three half-empty buildings within walking distance of each other, each with its own principal, engineer, and heating bill, and none with enough students to justify a clinician. Nothing done inside any one of those buildings changes that. If the goal is a center that stays open five days a week, some schools have to get bigger, and combining under-enrolled schools into fewer, fuller buildings produces both the enrollment a center needs and whole buildings rather than scattered spare rooms.

Chicago has done this badly before, and the memory is earned: consolidation justified by cost is a cut, and communities read it as one, correctly. The argument here runs the other way, consolidate in order to concentrate, and the test of any proposal is whether the receiving building ends up holding things the sending buildings did not, a health center, a full-time counselor, a librarian, a complete course catalog, funded and under contract before anyone moves rather than promised afterward. The map takes no position on which buildings those should be. “Underutilized” is CPS’s label, spare classrooms are arithmetic on homeroom counts that changes when you move the class-size slider, and deciding what to combine takes enrollment projections, program fit, travel routes and safe passage, building condition, and the judgment of the people who live there, none of which is on the map and none of which belongs there. What the map can show is where the question is worth asking.

On 2026-11-03, Chicago elects all 21 seats of its first fully elected Board of Education, 20 from subdistricts and a president citywide, from about 43 candidates left on the ballot after challenges to the 51 who filed, to be seated in 2027-01. It is the one election in which the whole board turns over at once, and the first in which a school health agenda could be put to voters as a platform rather than left to a partnerships office. A board that wanted to run on it would have four things to decide in its first year.

First, a target and a map. Name the community areas in the third section, set a number of new primary-care and behavioral-health centers, and require the CEO to bring a license for each to the Board rather than executing it under delegated authority, so that the terms are public and comparable. Second, a standard deal: a ten-year license at nominal rent with utilities and custodial hours carried by the district, a data-sharing agreement that lets the sponsor’s visit records be matched to attendance for evaluation, and a consent packet folded into enrollment so that the October 15 deadline is met in the building. Third, amend the space-utilization standard so a licensed clinic counts as used space; a district that scores its own co-location as continued underutilization has told sponsors what it thinks of them. Fourth, put the nurses and the centers under one line of authority in OSHW, so the referral from the health office to the clinic down the hall is a policy rather than a favor.

What to ask Springfield for

The centers’ money problem is a state problem, and a board is a lobby. The upfront money exists. Illinois will receive up to $768 million over ten years from the $17.1 billion multistate settlement with Meta announced in 2026-08, designated for youth mental health and online safety and still awaiting court approval. The Illinois Federation of Teachers wants it spent on the education funding gap. Governor Pritzker has said one-time money should go to one-time needs and that Chicago’s shortfall is not one of them; the Attorney General wants it spent on the harm the lawsuit alleged. Building behavioral-health capacity into school-based centers is both. The counseling room, the exam room, the telehealth cart, and the records integration are one-time costs; the clinician’s salary is paid by billing afterward. A capital grant for center build-outs, drawn on the settlement and restricted to mental health capacity, would put the state’s one-time money against the litigated injury in the buildings where the affected teenagers already are.

The ongoing money is the harder problem. The IDPH school health center grant sat at $4.28 million a year from FY2017 through FY2023, rose to $6.63 million in FY2024 and FY2025, and stands at $7.26 million in FY2026 and FY2027; in 2021 it funded almost 60 percent of the state’s certified centers, and it rests on an administrative rule rather than a statute of its own. Illinois Medicaid already waives prior authorization for center visits, which is more than most states do. Four things would change the arithmetic.

Let centers bill private insurance. A center today writes off the visit of a student whose parent has employer coverage, because the sponsor is not in the plan’s network and cannot force its way in. Connecticut has required insurers since 2010 to offer any school-based health center that asks a contract on terms similar to those they offer other providers; New York in 2023 went further for school-based mental health clinics, requiring commercial plans to reimburse them whether or not they are in network, at a negotiated rate or, failing one, no less than the Medicaid rate. An Illinois version would combine the two, and let the sponsor decide whether to collect the plan’s co-pay or waive it, so that a family with coverage contributes something and a family that cannot contributes nothing. Privately insured students are a minority in the buildings that need centers most, and the revenue would be a fraction of the Medicaid base. It is still revenue on visits that currently earn none, and every additional payer makes a site less dependent on the one that is about to shrink.

Make Medicaid managed care pay for the visit. Louisiana, Maryland, Michigan, and New Mexico require Medicaid managed-care plans to pay for a student’s self-referred visit to a school-based center even when the center is out of network. Illinois runs its Medicaid program through managed-care organizations; a HealthChoice Illinois requirement of the same kind would end the negotiation each sponsor now conducts, plan by plan, for the right to be paid for a visit the state already covers.

Give the grant a statute and an index. A named line in the appropriations bill, a per-site floor, and an inflation adjustment would end the pattern of seven flat years followed by a catch-up. And claim what the district can. Federal Medicaid policy has let school districts bill for covered health services to any Medicaid-enrolled student, not only those with an IEP, since 2014; Illinois districts have been able to since 2023-04-18, when CMS approved the state’s plan amendment, retroactive to 2021-07-01. CPS bills under that stream separately from its sponsors, and a share of what it recovers for nursing services could fund the utilities and custodial hours it carries in a license.

The tools are on the table: a license form, a certification code, a billing rate, a grant line, a settlement fund, and 265 buildings the district already says have room. What has been missing is a board willing to say what the rooms are for. Part two turns to the Park District’s 743 buildings.