Higher education institutions face converging risks in student mental health, Medicaid-driven coverage gaps, new athletic liability from the June 2025 House v. NCAA settlement, and cross-border coverage exposure in study abroad programs. This article outlines five steps institutions can take to build a coordinated risk strategy that closes coverage gaps before they become liability or retention problems.
Higher education leaders are facing a convergence of pressures that is materially different from the risk management landscape they faced even several years ago. Student mental health, federal regulatory uncertainty, athletic liability, and global mobility are all shifting at once, and they’re increasingly interconnected.
Federal Medicaid changes threaten coverage for millions of college students, with downstream implications for campus health services, affordability, and retention. At the same time, a landmark legal settlement in college athletics has created new employer-like liability for institutions that existing insurance programs weren’t designed to handle.
Managing each of these risks in isolation is no longer sufficient. Protecting students and institutional stability requires a coordinated approach that connects coverage, compliance, and risk strategy.
Pressures Are Growing and Evolving
Each of the pressures outlined above carries distinct insurance and liability implications. Understanding how they manifest and intersect is the starting point for building a more resilient risk strategy.
Mental health and the coverage gap. Student mental health has become one of the leading drivers of attrition in higher education. According to a Hope Center for Student Basic Needs survey conducted across 91 institutions in recent years, 57% of students who stopped out cited mental health as a contributing factor. Such findings make clear that this is as much a retention and financial risk for institutions as it is a student wellness issue.
As demand for mental health and telehealth services has grown, provider access gaps have become more visible and more consequential.
Federal regulatory uncertainty and Medicaid. The One Big Beautiful Bill Act introduced changes to Medicaid that are projected to reduce federal spending by more than $1 trillion over ten years, threatening healthcare access for approximately 3.5 million college students currently covered by the program.
For institutions, the downstream risks are significant: increased demand on campus health and counseling services, enrollment and retention pressure among low-income students, and potential liability exposure if care gaps lead to adverse outcomes. Student health plan design may also need to absorb a larger uninsured population, with cost implications that touch financial planning, not just risk management.
NIL and the new liability landscape in athletics. The June 2025 House v. NCAA settlement fundamentally altered the risk profile of collegiate athletics. Division I institutions that opt in can now directly compensate student-athletes — a shift that brings new and largely uncharted liability exposure. Existing athletic insurance programs were built around a different model. Title IX compliance questions around equitable NIL access, potential employment classification issues, and contract disputes involving third-party collectives are among the emerging exposures that now require active oversight and adaptable coverage frameworks.
Global mobility and cross-border coverage. Study abroad programs, international research opportunities, and athletic competitions overseas have become a standard part of the higher education experience. But when institutions send students abroad, the coverage structures that protect them on campus don't always follow. Health plans, liability coverage, and emergency response protocols built for domestic operations can leave meaningful gaps when a student is injured, falls ill, or encounters a crisis far from home.
Building a Coordinated Student Risk Strategy
At many institutions, risk management remains a fragmented function, with different teams overseeing different lines of coverage. A proactive, cross-functional approach bridges those divides by identifying blind spots, aligning policies with an evolving risk landscape, and getting ahead of exposures before a loss event occurs. The following considerations offer a starting point to build a coordinated strategy.
1. Review all coverage types together. Student health, travel, athletics, and commercial lines are often assessed in isolation. A comprehensive, cross-functional review can identify where coverage overlaps, where gaps exist, and where policies need to be updated to reflect the current risk environment.
2. Ensure access to mental health and telehealth services. As student health plans come under increasing pressure, institutions should evaluate whether current coverage adequately addresses mental health and telehealth utilization. Affordability gaps that go unaddressed become retention risks.
3. Establish cross-departmental ownership. Risk management, student affairs, finance, and athletics need to share accountability for student well-being. When these functions operate independently, exposures that span multiple areas go unmanaged.
4. Revisit policies annually. The regulatory and legal environment facing higher education institutions is shifting too quickly for static coverage frameworks. Annual policy reviews, with attention to NIL developments, healthcare regulation, and international programming, help ensure coverage keeps pace with institutional exposure.
5. Ensure consistent coverage for students wherever they are. Whether students are on campus, studying abroad, or competing internationally, coverage should follow them. Gaps in cross-border health, liability, and emergency response coverage represent a student safety issue and an institutional liability.
From Reaction to Readiness
The risk landscape facing higher education institutions isn't likely to stabilize anytime soon, and reacting to each new pressure as it arrives is no longer sustainable.
Aligning coverage, compliance, and care into a coordinated, proactive approach enables institutions to close protection gaps and strengthen their ability to support both student and organizational success.