Helping States Understand Their School Medicaid Program

By Alex Mays, Senior National Program Director

Over the past few years, thanks to a change in federal Medicaid policy, states have made considerable progress in improving children’s access to school health services covered by Medicaid. Almost a third of all states now cover eligible health services for all Medicaid-enrolled children, instead of only covering the services identified in a student’s Individualized Education Plan (IEP).

Still, many schools face challenges when seeking Medicaid reimbursement for delivering health services to eligible students. Among the most significant is the burden of determining which school health personnel are considered qualified for reimbursement by the state Medicaid program.

Healthy Schools Campaign has released a new report, “State Medicaid & Education Standards for School Health Personnel: A 50-State Review of School Reimbursement Challenges,” to help states better understand where instances of misalignment between state standards for nursing and behavioral health personnel and Medicaid requirements could prevent schools from receiving Medicaid reimbursement for covered services provided to eligible students.

The report is available at Healthy Students, Promising Futures, a Healthy Schools Campaign initiative to help states and school districts increase funding for and expand access to Medicaid-funded school health services.

The new HSPF website includes a new interactive map, State Data on Medicaid-Eligible School Health Services and Providers, detailing how state school Medicaid programs cover services, eligibility, billing providers, and school nursing and behavioral health personnel. Information is available for all 50 states and the District of Columbia.


Register Now for Related Webinar: Tuesday, Dec. 14
Medicaid & State Standards for School Health Personnel:
Making the Link to Medicaid Reimbursement for Student Health Services


Both the report and map enable policymakers, school districts, advocates and others to better understand their state school Medicaid program, including its strengths and opportunities for improvement.

Billing Challenges and Opportunities

The report, authored by Stacie Weeks and Julia Smith of Aurrera Health Group, provides new insights into the challenges schools across the country face in receiving Medicaid reimbursement for the health services provided by school nurses, social workers, psychologists, and counselors.

It also highlights billing challenges for other personnel who are authorized to work in schools but may lack the professional qualifications required by Medicaid.

Based on the information reviewed, almost a dozen states show some form of misalignment between the requirements defining provider qualifications for school nursing services for purposes of Medicaid reimbursement, and the state education standards used to qualify school nurses and other personnel to deliver nursing services in the school setting.

Instances of apparent misalignment between Medicaid reimbursement and state education agency standards for school behavioral health personnel were present in 20 states.

The report also identifies several promising practices among states that may help ease the burden on schools when billing Medicaid for school health services.

Specific state examples include: 1) ensuring information is readily accessible; 2) coordinating state agency oversight of Medicaid and education standards for school health personnel; and 3) recognizing special state certification programs for school health personnel for purposes of Medicaid reimbursement.

National and State Learning Collaboratives

To help advance state efforts, Healthy Schools Campaign provides technical assistance to states committed to expanding school health access and educates school and policy officials about changes to Medicaid policy.

A key component of this work is the HSPF Learning Collaborative; 15 state teams are offered a unique opportunity to share challenges and solutions and to engage directly with Medicaid policy experts and HSPF’s national partner organizations. New teams are accepted on a rolling basis.

In anticipation of Illinois, HSC’s home state, successfully expanding its school Medicaid program in 2021, HSC launched the Medicaid Expansion for School Health Learning Collaborative to convene school district teams from across Illinois to develop and implement strategies for expanding Medicaid billing for school health services and using the additional funds to provide new services and supports for students.

We invite anyone interested to join us on Dec. 14 for a timely webinar to learn more about the momentum around investments in school Medicaid programs — and how states can align their programs for sustainable funding.