Biden’s “Unity Agenda” Recognizes Role of School Medicaid in Mental Healthcare

March 02, 2022 | Written By:

President Joe Biden used his State of the Union address Tuesday night to call for a four-point “unity agenda” that includes providing resources for mental health, “especially among our children, whose lives and education have been turned upside down.”

In advance of Biden’s address, the White House released highlights of the administration’s plan to double the number of school-based mental health professionals. COVID-relief funds are providing a jumpstart for hiring. Now, the Department of Health and Human Services “will make it easier for school-based mental health professionals to seek reimbursement from Medicaid” to help schools sustain these roles, according to the briefing.

We have long known a key strategy for improving access to mental healthcare for children and young people is ensuring school districts are able to receive Medicaid reimbursement for health services delivered in schools. While Medicaid has a 30-year history of reimbursing for school-based health services, that reimbursement has primarily been limited to specific services included in a student’s Individualized Education Program (IEP). This means schools cannot bill for the majority of health services delivered to Medicaid-enrolled students.

In 2014, the Centers for Medicare and Medicaid Services (CMS) issued a letter allowing states more flexibility in their school-based Medicaid programs by permitting school districts to seek reimbursement for health services delivered to all children covered by Medicaid. Today, HSC works with states across the country, helping them to bring their Medicaid plans into alignment with what has become known as the “free care” policy reversal.

So far, 16 states have made the necessary changes. Some states that expanded access also added more types of health providers – including social workers and psychologists – to the list of providers who can bill Medicaid, which means more sustainable funding for schools. But even though there are a number of state success stories, some states have been reluctant to take action, especially without clear federal guidance.

Following a Senate Finance Committee hearing in February on youth mental health, HSC submitted recommendations for strengthening school Medicaid programs.

We believe these recommendations will help the Biden administration reach its goals of increasing the number of school health personnel and providing care to more students:

Require that all states expand their school Medicaid programs to cover all medically necessary services including prevention and early intervention – delivered to all Medicaid-eligible students in a school setting.

Require CMS to update both the Medicaid School Health Technical Assistance Guide and the Administrative Claiming Guide to better support states in designing and implementing their school-based Medicaid programs, including how to address significant implementation barriers faced by schools. The last federal guidance on school Medicaid programs was issued in 2003.

Provide an increased Federal Medical Assistance Percentage (FMAP) for health services provided in a school-based setting, including behavioral health services. An increased FMAP would both incentivize states and school districts to expand their school Medicaid programs and ensure school districts have access to sustainable funding to deliver behavioral health services to Medicaid-enrolled students.

Deepen funding for technical assistance to schools and state Medicaid programs by establishing a national Medicaid technical assistance center to support states and school districts in operating their school Medicaid programs. This could be modeled after the Mental Health Technology Transfer Center Network.

Provide states with funding to support small and rural school districts to implement and/or expand school mental health Medicaid programs – and provide ongoing technical assistance. This could include funds to train school health providers, educate school district billing departments, and provide dedicated state staff to coordinate between state Medicaid and education departments.

Issue a Request for Information on school-based Medicaid programs to better understand the challenges and opportunities facing school districts in billing Medicaid for school health services, including behavioral health services.

During last month’s Senate hearing, our colleague Sharon Hoover, co-director of the National Center for School Mental Health, called on Congress to encourage state Medicaid plans to cover all medically necessary mental health services, including prevention services, for all students enrolled in Medicaid. Her points were well-received, particularly by Republican Sen. Bill Cassidy of Louisiana, who asked about the outdated federal guidance around school Medicaid policy.

We were pleased then to see the Senate Finance Committee recognize the importance of school Medicaid programs, and we are doubly pleased today to see that the White House is prioritizing school Medicaid as a way of improving access to mental healthcare for all students.

New to school Medicaid and want to understand more about the opportunities it presents for supporting student health? Check out this primer from HSC: Schools Are Key to Improving Children’s Health

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