Free Care Policy

In 2014, the Centers for Medicare and Medicaid Services (CMS) issued a state Medicaid director letter reversing the free care policy. This change permits states more flexibility in their school-based Medicaid programs by allowing school districts to bill Medicaid for health services delivered to all Medicaid-enrolled children, not just those with a special education plan documented by an Individualized Education Program (IEP). Increasingly, states and school districts are seizing this new opportunity in Medicaid to expand access to and resources for school health services, which in many states entails changes to their state Medicaid plans and state guidance. States are increasingly pursuing these changes, recognizing the growing need to provide health services and supports to children where they spend the majority of their time: in school. 

For updates on state activity, please refer to the following brief: State Efforts to Implement the Free Care Policy Reversal

Featured Resources

resources Expanding Michigan’s School-Based Medicaid Program
October 8, 2019

This Healthy Students Promising Futures Learning Collaborative case study highlights Michigan's work to leverage the reversal of free care policy to expand the state's school-based Medicaid program. Beginning in October 2019, school districts in Michigan will be able to seek Medicaid reimbursement for services provided to all Medicaid-enrolled students (not only for health services included in a student's Individualized Education Program). This change presents an important opportunity to expand access to and resources for school health services, particularly behavioral health services

resources Medicaid and Schools State Policy Updates
July 17, 2019 Presentation PDF

Shannon Huska, Colorado Department of Health Care Policy & Financing; Jodi Patton, Nevada Division of Health Care Financing and Policy; Melinda Hollinshead, Public Consulting Group

resources Understanding the Role of Random Moment Time Study in School Based Medicaid Programs
July 16, 2019 Presentation PDF

Melinda Hollinshead, Public Consulting Group

resources State Efforts to Implement the Free Care Policy Reversal

This brief outlines some of the known actions to implement the reversal of the free care policy. Some of the information in this brief is based on informal conversations with policymakers and advocates. This document is updated as changes are known to the HSPF team.

resources Understanding Medicaid Reimbursement in the School Setting

"Presentation delivered by CMS for the Healthy Students, Promising Futures Learning Collaborative providing an overview of Medicaid reimbursement in the school setting. The presentation addresses issues including the free care policy, certified public expenditures and telehealth.

resources Medicaid and CHIP School-Based Health Services Affinity Group

This presentation provides an overview of the Medicaid and CHIP school-based health services affinity group.

resources Massachusetts School-Based Medicaid: Lessons Learned from Expansion/Free Care Preparations

Presentation from the December 2018 Healthy Students, Promising Futures symposium on MA’s school-based Medicaid program and their plan for expansion following approval of their free care policy reversal SPA.

resources CMS Approves State Plan Amendment for Massachusetts, Creating New Opportunity for School-based Medicaid

This brief provides an overview of the Massachusetts Medicaid state plan amendment (SPA) approved by CMS that enables schools to bill for Medicaid services provided to all Medicaid-enrolled students.

resources Policy Considerations for California Following the 2014 Reversal of the Medicaid “Free Care Rule”

This brief describes the federal policy change and recommends implementation steps that would maximize the potential for schools to play a strong role in transforming health care delivery.

resources LEA Medi-Cal & School-based Health Care

This presentation provides an overview of school-based health care in California.