Four Years After Bipartisan Safer Communities Act, More States Boost Student Access to and Medicaid Funding for School-Based Health Services
August 24, 2026
Four Years After Bipartisan Safer Communities Act, More States Boost Student Access to and Medicaid Funding for School-Based Health Services
New Healthy Schools Campaign report finds BSCA-mandated federal guidance and targeted investments prompted states to update school Medicaid policies and brought more funding into schools
Four years after the passage of the Bipartisan Safer Communities Act (BSCA), states are making significant progress increasing the array of Medicaid-funded school-based health services, improving access to care for students and strengthening the infrastructure needed to sustain school health programs, particularly those in rural areas, according to a new report from Healthy Schools Campaign (HSC).
Eight states have received federal approval since 2022 to allow school districts to bill Medicaid for more types of health services provided to more Medicaid-enrolled students, and more than a dozen other states have amendments pending — a substantial acceleration over previous years. Making these changes enables states to draw down additional Medicaid funding that can be reinvested in school health services that benefit all students.
The report, “A Catalyst for Progress: How the Bipartisan Safer Communities Act Helped Expand School Medicaid and Student Access to Health Services,” examines the impact of the BSCA’s school Medicaid provisions, which called on the Centers for Medicare and Medicaid Services (CMS) to update federal guidance, establish a technical assistance center and provide $50 million in state grants.
Together, these efforts were designed to help states expand health services in schools, including mental healthcare, and create more sustainable funding for the services schools provide.
“States are acting on the opportunity created by the Bipartisan Safer Communities Act to connect more students with the healthcare they need. These results demonstrate what is possible when states have the resources, guidance and support to expand access to care in schools,” said Jessie Mandle, HSC National Program Director.
The report identifies three major areas of progress:
- More states are expanding coverage beyond the IEP. Illinois, Maryland, New Mexico, Ohio, Oregon, Utah, Virginia and Wisconsin have received CMS approval to reimburse schools for services provided to students outside of an individualized education program (IEP). More than a dozen other states have amendments pending to expand services and/or student eligibility.
- Federal grants are strengthening state and local capacity. States that received BSCA grants are using funding to hire school Medicaid staff, improve billing systems, provide training and technical assistance and strengthen partnerships with school districts.
- More comprehensive programs are generating additional federal funding. Expanding Medicaid claims to include more students, services and provider types allows states and school districts to draw down additional federal funding and reinvest those dollars in school health services.
The financial impact is already evident. In Illinois, school districts drew down nearly $17.8 million in new federal Medicaid funding for services outside the IEP in the first year after the state expanded billing to all Medicaid-enrolled students. In the second year, districts received $23.4 million in additional federal funding for those services.
In Michigan, the state received more than $19.6 million in federal reimbursement in 2025 for services provided to students without IEPs, following the expansion of its school Medicaid program. Billing for students with IEPs also increased by more than $86.9 million per year after the state added school psychologists to the list of providers eligible to bill Medicaid.
The report also highlights how federal grants are helping states address infrastructure barriers to school district participation. In Nevada, grant funding supported a statewide needs assessment and an electronic health record and billing system. More than half of the state’s 18 local educational agencies are now actively billing Medicaid.
The progress comes as states face new pressure on Medicaid budgets. The federal budget law enacted in July 2025 cuts approximately $1 trillion in federal Medicaid funding over the next decade. Although the law does not place limits on school Medicaid, broader reductions in federal Medicaid funding could put pressure on states to reduce benefits or school-based health services.
“As states and school districts face significant federal cuts, school Medicaid reimbursement is more important than ever,” said Mandle. “Maximizing school Medicaid can help mitigate the impact of those cuts and protect and strengthen critical health services for students.”
The report concludes with specific recommendations for how continued federal and state leadership can help sustain this momentum, connect school Medicaid efforts with rural health investments and maximize the impact of school Medicaid programs for students and schools.
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About Healthy Schools Campaign
Healthy Schools Campaign (HSC) engages stakeholders and advocates for policy changes at local, state and national levels to ensure that all students have access to healthy school environments, including nutritious food, physical activity and essential health services, so they can learn and thrive. HSC’s Healthy Students, Promising Futures initiative supports states and school districts in expanding access to Medicaid-funded school health services. To learn more, visit healthyschoolscampaign.org and healthystudentspromisingfutures.org.
