Introduction to Medicaid Funding for School-Based Services
In recent years, the role of schools in providing comprehensive health services has expanded significantly. The federal government has recognized this need and offers substantial Medicaid funding to schools to enhance access to quality physical, mental, and behavioral health services for eligible students. These funds are crucial for students with disabilities under the Individuals with Disabilities Education Act (IDEA) and students from low-income families enrolled in Medicaid or CHIP programs.
The Importance of Expanding Medicaid Plans
Currently, most states have Medicaid plans that allow reimbursement for health services provided to students with disabilities under IDEA. However, only 16 states have expanded their plans to include services for all Medicaid-eligible students, not just those receiving services under IDEA. This expansion is critical as it could potentially provide thousands of additional students access to essential health services, thereby utilizing all available federal funds to support them.
Steps to Expand Medicaid School-Based Services
States can take actionable steps to broaden Medicaid school-based services for all Medicaid-enrolled students. Here’s how:
- Review and Amend State Plans: State Educational Agencies and State Medicaid Agencies (SMA) should collaborate to review the current State Plan approved by the Centers for Medicare & Medicaid Services (CMS). They should discuss necessary changes to expand Medicaid reimbursement for all eligible students. The Comprehensive Guide to Medicaid Services and Administrative Claiming by CMS can serve as a valuable resource.
- File a State Plan Amendment (SPA): SMAs can file an SPA with CMS, documenting the state’s decisions about reimbursable school-based services and the requirements for the professionals providing these services. The CMS’s Medicaid State Plan Amendment (SPA) Toolkit provides resources like guides, templates, and checklists to aid in developing the SPA.
- Utilize Federal Technical Assistance: Collaborate with the federal Medicaid and School-Based Services Technical Assistance Center to ensure efficient service delivery and reimbursement. Sharing resources with local educational agencies (LEA) and learning from other states' best practices can further enhance service expansion.
Benefits of Medicaid Funding for School-Based Services
Nationally, over half of all school-aged children and youth are covered by Medicaid. By making health services accessible in schools for all Medicaid-enrolled students, we can significantly increase the number of students receiving these services and reduce the burden on families. Studies show that students are six times more likely to access mental health care when these services are available in schools.
Medicaid contributes $4-6 billion annually to school districts for providing school-based services, serving as a major funding source for many LEAs. For instance, Chicago Public Schools receives $35-40 million annually in Medicaid reimbursement, expecting an additional $10 million due to federal flexibilities introduced in the 2023 CMS claiming guide.
Case Studies: Successful State Expansions
Several states have successfully expanded their Medicaid programs, resulting in increased federal funds:
- Colorado: A pilot project estimated an additional $8 million in federal Medicaid funds annually by allowing claims for additional school behavioral health providers.
- Georgia: By allowing reimbursement for school nurses, the state expects $48.6 million in federal revenue to its school-based Medicaid program.
- Michigan: Projects an increase of $14 million after expanding its program to include services provided by master’s degree-level school psychologists.
Conclusion: Take Action Now!
Currently, only 16 states are maximizing available Medicaid funding by allowing reimbursement for school-based services provided to more than just students with disabilities under IDEA who are Medicaid-enrolled. All other states have the opportunity to amend their State plans to include school-based services for all Medicaid-enrolled students. Expanding these services can address student needs directly, boost student achievement, and improve life outcomes.
For more information, please follow this link.
