State Data on Medicaid-Eligible School Health Services & Providers
In 2014, the federal government reversed a longstanding Medicaid policy, known as the free-care rule, that limited the ability of school districts to seek Medicaid funding for student health services.
The policy shift invited schools to assume a greater role in improving the health of low-income students by permitting billing for all eligible health services provided to all students with Medicaid coverage. But some states had codified the older policy in state law. To fully leverage available funds, those states need to bring their Medicaid plans into alignment with federal policy.
The map and state data below provide an overview of each state’s current school Medicaid program, including the types of school health services and providers eligible for Medicaid reimbursement. School district leaders and children’s health advocates, along with representatives of state Medicaid and education agencies, can use this information to strengthen and expand school Medicaid programs.
The accordion section below the map includes Medicaid-covered services, eligibility and billing providers, plus Medicaid-qualified school nursing and behavioral health personnel in all 50 states and the District of Columbia.
How to Use the Tabs
School Medicaid Expansion: Shows states that have successfully expanded eligibility for all students enrolled in Medicaid, and their method for doing so.
School Health Providers: Identifies the types of school health personnel currently qualified in each state to seek Medicaid reimbursement, focusing on providers delivering school nursing services and school-based behavioral healthcare.
Promising Practices: Highlights actions that could make it easier for schools to determine the types of Medicaid-qualified school health personnel.
Overview & Methods
This state data provides details regarding Medicaid coverage for nursing services and behavioral healthcare in the school setting in all 50 states and the District of Columbia. It includes:
Covered Services: Does Medicaid cover school-based health services? If yes, what types are covered?
Eligibility: Who is eligible for school-based services?
Billing Provider: Who is eligible to “bill” for services rendered in a school?
Nursing Services: What types of nursing services are covered and what are the provider qualifications for reimbursement?
Behavioral Healthcare: What types of behavioral health services are covered and what are the provider qualifications reimbursement?
Prepared by the Aurrera Health Group for Healthy Schools Campaign, this information was compiled using mostly publicly available information, including state law, Medicaid Provider Billing Manuals, Medicaid State Plans, and other relevant information about the coverage of health services in school settings.
Nothing in this matrix constitutes or should be considered as legal or compliance advice. Furthermore, this information is based upon review of documentation publicly available as of June 2021 and is subject to change at any time. The information does not account for changes that may have been made to Medicaid coverage and requirements related to COVID-19. It also does not account for coverage of Applied Behavioral Analysis for Autism. While not specifically detailed in the grid, states generally require all healthcare practitioners to be licensed or certified in the state where they are practicing, and services are typically limited to those within the practitioner’s scope of practice under state law. Contact individual states to verify Medicaid program requirements.
This tool was made possible with support from
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