May 9, 2022
Given the growing concern about student health, particularly mental health, and recent national policy efforts to increase access to school health services, Healthy Schools Campaign has developed new and updated guidance on how school districts can seek Medicaid reimbursement to expand physical, behavioral and mental health services.
An online campaign, #SchoolMedicaidMatters, will run May 9-13 to raise awareness of federal policy and funding opportunities. A social media toolkit is available with resources, sample messages, graphics and more.
So far, 17 states have altered their state Medicaid plan to allow school districts to receive reimbursement for health services provided to all students enrolled in Medicaid – instead of being limited to students with an IEP – and five more states, including Illinois, have started the process.
But the majority of states still have to bring their Medicaid plans up to date with federal policy so school districts can leverage funding.
The resources cover all aspects of the process, from how to get started with amending a state Medicaid plan to adding more types of school health personnel considered eligible for Medicaid reimbursement. (One of the tricky things for school districts is that a health provider can be licensed and qualified to provide a Medicaid-eligible health service, but if they’re not included as a “Medicaid-qualified” provider in the state plan, the school can’t seek reimbursement for the service.)
States that have updated their plan to more accurately reflect the types of health providers working in schools receive more federal funding – and these funds can be used as general revenue or reinvested in school health services, enabling districts to add more staff, including school nurses, counselors, social workers and psychologists, to address student health needs. This policy brief shows how six states ensured that school health providers are recognized as Medicaid-eligible.
HSPF’s interactive map shows detailed information about Medicaid-eligible services and school nursing and behavioral health personnel in all 50 states and D.C.
Issue-Specific Policy Briefs
In addition, HSC has published several new policy briefs that address school Medicaid billing and plans of care.
- School Medicaid: Documenting Medical Necessity Through Plans of Care
The 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.
- Third Party Liability and School-Based Medicaid Services
School Medicaid programs must comply with federal, state and local school district requirements. This brief includes information on how third party liability (TPL) applies to school-based health services and offers resources for additional reading.
- Office of the Inspector General School-Based Medicaid Reports: A Consolidated Review
This report reviews 33 audits of school-based Medicaid programs conducted by the Office of the Inspector General and summarizes key findings. Sample checklists are included to help guide states toward developing internal guidance and policies that meet OIG expectations.
Breaking down these complex issues is one of the ways HSC is working to remove barriers that might be delaying health and education agencies from taking action. We also advise state teams in our Healthy Students, Promising Futures Learning Collaborative and provide the opportunity for them to learn from national policy experts and each other. A similar learning collaborative is underway specifically for Illinois school districts.
We invite you to join our #SchoolMedicaidMatters online campaign as we work to increase awareness about the role of school Medicaid. If you have any questions about the campaign, please contact Viviana Garcia-Blanco.
Cross-posted at Healthy Schools Campaign.