Resources

This memo summarizes new school Medicaid guidance released in May 2023 by the Centers for Medicare and Medicaid Services (CMS) and also draws from CMS’ August 2022 Informational Bulletin. It provides an initial assessment of how states could move forward to expand and enhance their school Medicaid programs.

This guidance makes clear that:
● All Medicaid-enrolled students can be covered for school-based health services.
● All medically necessary services, including preventive, physical, mental health and substance use disorder services can be covered in a school setting.
● States are able to support a wide range of providers in a school setting.
● Students covered by CHIP can be included in school Medicaid.

The School Medicaid Survey was developed to provide visibility into how each state sets up its school Medicaid program and to enable states to find programs that might be similar to theirs. The Survey includes information about school Medicaid expansion, billing and reimbursement, administrative claiming, state audits, random moment time studies, and more.

All 50 states plus the District of Columbia (D.C.) were invited to participate; a total of 38 states and D.C. responded. Information was provided by state Medicaid and state education agency staff between April and December of 2022.

Presentation slides from a June 6 webinar on the newly published school Medicaid guidance are now available online.

Featuring CMS Administrator Dan Tsai and OSERS Director Katy Neas, the webinar was co-sponsored by Healthy Schools Campaign, AASA and the National Alliance for Medicaid in Education (NAME).

The webinar covered:
● Policy shifts in the new school-based services Medicaid guidance
● Complementary policy changes at the U.S. Department of Education to expand school-based Medicaid reimbursement
● How the new guidance will reduce the administrative burden on districts and states
● Steps and supports available to states to expand and strengthen their school-based Medicaid programs
● How AASA, NAME and HSC can support state and district implementation efforts

Expanding school Medicaid programs presents an important opportunity for states to support school districts in drawing down additional, sustainable federal Medicaid funding for school health services. Estimates suggest that states can expect to see significant increases in new federal resources. This brief includes five state examples.

Healthy Schools Campaign partnered with Council of Chief State School Officers, National Center for School Mental Health, and other organizations from the Collaborative for Student Success to promote leveraging Elementary and Secondary School Emergency Relief (ESSER) funds as an important way to build the capacity of state and local education agencies to support wellbeing in schools.

The Healthy Schools Campaign School Medicaid Database is a text-searchable collection of publicly available documents pertaining to school Medicaid programs (as of 2022) in all 50 states and the District of Columbia.

Developed to assist state education agencies (SEAs) and state Medicaid administrators in creating resources to support school districts with expanding Medicaid reimbursement for school health services, the database features links to state Medicaid and education agency websites and to specific documents related to school Medicaid billing.

To assist Healthy Schools Campaign in advising states and stakeholders on how to strengthen Medicaid coverage of crisis services in schools, Aurrera Health Group conducted research on Medicaid coverage of school-based behavioral health and physical health crisis services in 11 states: Arkansas, Alaska, California, Georgia, Idaho, Indiana, Maine, Massachusetts, Michigan, Missouri, and North Carolina.

This memorandum describes Aurrera's findings from this research and provides recommendations for states seeking to establish or strengthen their coverage of crisis services.

In August 2022, the Center for Medicaid and CHIP Services at the Centers for Medicare and Medicaid Services released an informational bulletin, "Information on School-Based Services in Medicaid: Funding, Documentation and Expanding Services."

This brief highlights key points and suggests how school Medicaid stakeholders — including school districts and state Medicaid and education agencies — can use the bulletin to assess where they can strengthen their programs. The brief also provides a high-level overview of the bulletin's School-Based Health Services Checklist, which feature strategies and guidance to implement or enhance school-based health services.

This brief details how a school Medicaid technical assistance (TA) center can play a key role in ensuring states and school districts have the necessary supports to implement, strengthen and expand their school Medicaid program to meet the needs of children and youth.

As young people across the country experience unprecedented levels of mental and behavioral health needs, it is important for states and school districts to understand the types of funding available to pay for appropriate services. This brief considers the circumstances under which school districts can bill their state Medicaid program for sudden and acute mental health crises that students may experience.

Expanding school Medicaid programs presents an important opportunity for states to support school districts in drawing down additional, sustainable federal Medicaid funding for school health services. Estimates suggest that states can expect to see significant increases in new federal resources. This brief includes five state examples.

The policy brief explains the importance of using a plan of care to document medical necessity, which is required for all school health services submitted for Medicaid reimbursement, and offers guidance on implementing plans of care for students without an IEP or 504 plan.