Support From Centers for Medicare & Medicaid Services


The Centers for Medicare & Medicaid Services (CMS) has been very supportive of states’ efforts to expand access to school health services, engaging directly with state Medicaid agencies to support the development of state plan amendments and moving quickly to approve them.

CMS has issued several guidance documents — including a July 2019 bulletin, “Guidance to States and School Systems on Addressing Mental Health and Substance Use Issues in Schools” — that recommend schools as an ideal site for meeting the health needs of children and specifically call out the 2014 reimbursement policy clarification as an opportunity to support this work.

Initially, however, states were cautious about moving forward with implementation. This was due to a number of factors, including the lack of updated guidance on school-based Medicaid claiming, concerns about the Trump administration’s support for Medicaid, and the release of a series of high-profile audits of school-based Medicaid programs. And, given that school Medicaid programs represent only 1 percent of overall Medicaid expenditures, it didn’t immediately catch the attention of state policymakers and other decision leaders.

Today, numerous issues — including student mental health needs, the opioid epidemic and increased attention around school safety — are driving momentum for states to leverage the opportunity to expand school health services. The early adopters that received approval to move forward with this change are already proving the importance and value of this effort. They have provided a roadmap for other states to follow.

In June 2019, the Kentucky Commissioner of Education and Kentucky Medicaid Commissioner sent a letter to all school superintendents that noted:

When students have access to high-quality behavioral health services in the school building, including from clinically trained professionals, they can receive preventive treatment to address challenges before issues get more serious, require more costly interventions, and potentially put other students at risk.

Given Medicaid’s historic role in supporting children’s health and educational outcomes, ensuring that all eligible students in your district are enrolled in Medicaid and have access to the school-based health services they need are key strategies to supporting a healthy learning environment and academic success.