January 24, 2023
Can Medicaid cover school-based behavioral and physical health crisis services — and if so, how? It’s a question that state teams in the Healthy Students, Promising Futures Learning Collaborative have been discussing for some time, sharing information with each other to help illuminate which states are taking this step.
Healthy Schools Campaign asked Aurrera Health Group to research this issue, and Aurrera did a deep-dive into the status of 11 states, reviewing their Medicaid state plan, Medicaid agency guidance, and when relevant, guidance from other agencies or departments that govern school Medicaid.
Aurrera’s final report, Medicaid Coverage of School-Based Health Services: Analysis and Recommendations Based on a Review of Eleven States, found that only two of the studied states clearly provide coverage for physical health crisis (PHC) services and one additional state appears to do so.
Nine of the 11 states appear to provide coverage for behavioral health crisis (BHC) services, but only four of those states specify the conditions for coverage in state guidance.
From the report:
The other five states provide little to no direction as to the state’s conditions for coverage of BHC services, such as applicable eligibility or documentation requirements. Several of these states do not directly address BHC services in their guidance — but they do provide a billing code for BHC services in their fee schedule for LEAs, suggesting that coverage is, in fact, provided.
Model states were also highlighted. Four states — Massachusetts, Michigan, Arkansas and Idaho — stood out for their coverage of BHC services and the clarity of their policies.
The report also provides policy recommendations for states seeking to establish or strengthen their coverage of crisis services and briefly addresses the steps states may need to take to implement those recommendations — information that can help all states make informed choices when designing their school Medicaid programs.