Free Care Policy
In 2014, the Centers for Medicare and Medicaid Services (CMS) issued a state Medicaid director letter reversing the free care policy. This change permits states more flexibility in their school-based Medicaid programs by allowing school districts to bill Medicaid for health services delivered to all Medicaid-enrolled children, not just those with a special education plan documented by an Individualized Education Program (IEP). Increasingly, states and school districts are seizing this new opportunity in Medicaid to expand access to and resources for school health services, which in many states entails changes to their state Medicaid plans and state guidance. States are increasingly pursuing these changes, recognizing the growing need to provide health services and supports to children where they spend the majority of their time: in school.
For updates on state activity, please refer to the following brief: State Efforts to Implement the Free Care Policy Reversal
This Healthy Students Promising Futures Learning Collaborative case study highlights Michigan's work to leverage the reversal of free care policy to expand the state's school-based Medicaid program. Beginning in October 2019, school districts in Michigan will be able to seek Medicaid reimbursement for services provided to all Medicaid-enrolled students (not only for health services included in a student's Individualized Education Program). This change presents an important opportunity to expand access to and resources for school health services, particularly behavioral health services
Melinda Hollinshead, Public Consulting Group
This brief outlines some of the known actions to implement the reversal of the free care policy. Some of the information in this brief is based on informal conversations with policymakers and advocates. This document is updated as changes are known to the HSPF team.
"Presentation delivered by CMS for the Healthy Students, Promising Futures Learning Collaborative providing an overview of Medicaid reimbursement in the school setting. The presentation addresses issues including the free care policy, certified public expenditures and telehealth.
This presentation provides an overview of the Medicaid and CHIP school-based health services affinity group.
Presentation from the December 2018 Healthy Students, Promising Futures symposium on MA’s school-based Medicaid program and their plan for expansion following approval of their free care policy reversal SPA.
This brief provides an overview of the Massachusetts Medicaid state plan amendment (SPA) approved by CMS that enables schools to bill for Medicaid services provided to all Medicaid-enrolled students.
This brief describes the federal policy change and recommends implementation steps that would maximize the potential for schools to play a strong role in transforming health care delivery.