Schools are places where health care takes place, an essential part of the country’s public health infrastructure. During COVID-19, schools across the country responded to call to action immunize students and community members and provide nutritious meals and mental health counseling services to the children – despite the closed classrooms. Even before the pandemic, schools were providing care that supports classroom learning for 14% from public school children with special health care needs, including those with chronic physical, developmental, behavioral or emotional conditions.
A recent JAMA Pediatrics study found that schools are “the de facto mental health systemprogram, providing services to 57% of adolescents who needed care before the pandemic. In 2019, centers for disease control and prevention found 37% of high school students reported lingering feelings of sadness or hopelessness; 19% having seriously considered suicide; and 9% having attempted suicide. And the need is even deeper now. From April to October 2021, the proportion of pediatric emergency department visits related to mental health increased by almost a third for 12-17 year olds and 24% for children 5-11 years old.
As is always the challenge of public education, the needs far outweigh the available resources. But changes to federal Medicaid payment policy have paved the way for schools to access millions of dollars to fund school nursing, behavioral health and other services in schools.
For example, in 2014 the Centers for Medicare and Medicaid Services expanded a long-standing network Politics to allow schools to be reimbursed for providing covered services to any Medicaid-eligible child. But only 17 states took advantage of this funding stream by modifying their state Medicaid plans (the document that defines the types of services and providers eligible for reimbursement) to reflect the new policy.
Michigan modified its state plan to include behavioral health analysts, school social workers, and school psychologists as covered providers, while the state legislature approved $31 million to fund behavioral health providers in schools. Since this change, there has been approximately one 6% increase in the amount of Medicaid reimbursement directed to schools. Louisiana changed its state Medicaid plan in 2015 and saw a 30% increase in Medicaid income as school nurses increased by 15%. Last year, Georgia changed its plan to allow Medicaid to pay for more school health services. Half the children of Georgia are covered by Medicaid or the state’s PeachCare system, so this change is dramatic and creates an opportunity to bring hundreds of millions of dollars to Georgia school districts to support the most vulnerable students.
More states can position themselves to take advantage of Medicaid funding for schools by clarifying and expanding the scope of school health services and providers covered in their state Medicaid plans. However, some schools face additional hurdles, such as complex billing processes. This question is addressed in the Bipartisan Safer Communities Act, which directs federal policymakers to issue guidance, launch a help center, and release $50 million in planning grants over the next 12 months to help state Medicaid agencies and local educational entities navigate these challenges. These supports are likely to include strategies and tools to reduce billing administrative burdens, especially for rural schools, and best practices that schools and state Medicaid agencies can use to modify plans. so that the services students need and the providers who provide them become eligible for Medicaid reimbursement.
The National Collaborative for Healthy Schools 10-year roadmap for healthy schools prioritizes maximizing schools’ ability to bill Medicaid for school health services and, importantly, recognizes that when health and education officials do not collaborate, it is very difficult to achieve this objective. School nurses, district administrators, and state education officials should be prepared to work with state Medicaid agencies to take advantage of the supports the law will provide – prepare health needs data of their school communities, the types of services provided in schools (and that schools could begin to provide if reimbursed) and the types of licenses and credentials required for staff providing services in schools. State Medicaid officials can then ensure that changes to the state plan reflect the exact types of services students need and schools are able to provide.
How else can school nurses, district administrators and national education officials prepare?
- To find states reimburse Medicaid. Share information about upcoming supports to increase access to Medicaid funds for school health services and providers.
- Engage with the school or district Student Health Advisory Committees to gather community feedback on the health services they want to access, understand the unmet health needs of school communities, and increase awareness of the availability of Medicaid services at school.
- Review the Community health needs assessments local hospitals to better understand the important health needs of the community and the resources available to meet those needs.
- Make connections at the state Medicaid agency and advocate for reimbursement of school providers for specific services (e.g. counselling, personal care, case management, vaccinations) that are a priority for students.