August 28, 2023
Five months after the Centers for Medicare and Medicaid Services (CMS) released new school Medicaid guidance, there are signs that more states and school districts are taking steps to ensure schools can maximize federal funding for school health services.
Healthy Schools Campaign led advocacy efforts to get CMS to provide states with updated guidance and other supports, including technical assistance and state grants, all of which were included in last year’s Bipartisan Safer Communities Act.
The guidance, which simplifies Medicaid billing and reduces the administrative burden on schools, is designed to help states and school districts pivot to allowing Medicaid billing for all eligible health services provided to all students enrolled in Medicaid, instead of limiting billing to services included in a student’s Individualized Education Plan (IEP). Making this shift can greatly increase funding for school-based healthcare, including mental health services.
In a recent NPR report, Portland Public Schools was cited as an example of a district that had found the original billing system too cumbersome and, as a result, has not billed for all Medicaid-eligible health services. The district now intends to do so under the new guidance. Axios teamed up with NPR on the story and published two companion pieces — a closer look at Portland Public Schools and a good synopsis of how Medicaid can boost school health funding.
NPR cited HSC’s count of states that have expanded billing outside of a student’s IEP, which has since grown to 25 states, with more state expansions underway.
In Illinois, HSC’s home state, school districts now can access federal funds for healthcare delivered to all 800,000 students enrolled in Medicaid, including 235,000 students in Chicago alone, instead of only billing for health services provided to the 14 percent of Medicaid-enrolled students with an IEP. HSC provided technical assistance and peer-learning opportunities to Illinois school districts, including Chicago Public Schools (CPS), via its Medicaid Expansion for School Health program.
NPR noted the funding CPS has received:
Chicago schools have already been getting tens of millions of dollars from Medicaid. Thanks to a recent update to Illinois’ state Medicaid plan, the district can take advantage of the changes Medicaid announced in May and get millions more.
“This is for services already being provided,” said Katherine Yager, the school system’s billing specialist. Schools already need to offer students diabetes management, medication administration, asthma control and other health care. “And then, as we look outside of that, we’ll be looking at things like crisis intervention services, other types of mental and behavioral health supports that the school district also provides.”
Dan Tsai, deputy administrator and director of the Center for Medicaid & CHIP Services at CMS, talked with NPR about the benefits of children being able to access healthcare at school and the funding schools can receive for health specialists and services.
“It’s not only efficient,” said Tsai, “but it’s probably one of the most effective ways we can reach a broad set of populations — in particular, kids and school-age youth who are in underserved communities.”
While schools can only bill for eligible services provided to Medicaid-enrolled students, the funding can be used to reinvest in school health services. That means districts might be able to hire additional counselors and other health providers, which benefits all students.
“It’s not just for those students [in special education]. Those students need it. We’re required to provide those services for those students,” Wendy Niskanen, a board member for the National Association of School Nurses, told NPR. “But the need is so much broader, and we need to make sure that we’re addressing school health so that students can be in school safe and ready to learn.”
HSC tracks state activity and provides support to states seeking to expand Medicaid-funded school health services through its Healthy Students, Promising Futures initiative. More examples of the financial benefits that states have experienced, particularly around mental health services, are available here.