Guide for Stakeholders to Support Implementation of the Free Care Policy Reversal

May 25, 2016

Healthy Schools Campaign recently developed a guide to support stakeholders across the country in increasing access to and resources for school health services through implementing the free care policy reversal.

As we have written about before, the December 2014 reversal of the free care policy presents an important opportunity to increase access to and resources for school health services. While the December 2014 State Medicaid Director letter clarified that school health services delivered to the general student population, not just those included in student Individualized Education Programs (IEPs), are eligible for Medicaid reimbursement, action is required from states and school districts to implement this change.

Healthy Schools Campaign has been working with advocates across the country to support states in implementing this policy change. Through this work, we have identified a series of steps that stakeholders can take to develop and implement a plan for leveraging the change in the free care policy to support increased access to comprehensive and coordinated school health services. Our Stakeholder’s Guide to Implementing the Change in the Free Care Policy highlights these steps which include the following:

Understand your state regulatory environment

Each state must decide to allow school districts to bill for the health services delivered to students. In many states, this will require an amendment to the state Medicaid plan since most states currently do not allow schools to bill for health services delivered to students without individualized education programs. If you are interested in learning more about what would be required to implement the change in the free care policy in your state, we encourage you to start by familiarizing yourself with your state Medicaid plan to better understand what school health services are currently recognized in your state plan.

In addition to understanding your state Medicaid plan, it is important to look at any barriers to implementing the change in the free care policy that are created by state laws. For example, a small number of states have included the free care policy in state law, in addition to their state Medicaid plan. While this is not the case in most states, it is important to reach out to state decision makers to determine if state law will present a barrier to implementation of the free care policy.

Understand the current school health services environment

Developing an understanding of the current school health services environment within a school district is critical step towards supporting the effective implementation of the change in the free care policy. This can be done by assessing student health needs to better understand the student health conditions in a given community and looking at the current school health infrastructure—the number and types of school health providers and district’s billing infrastructure. Once student health needs have been assessed and there is an understanding of a district’s capacity to deliver and bill for school health services, a model for delivering school health services under the change in the free care policy can be developed.

Engage decision makers and allies

Identifying and engaging key decision makers throughout this process is important to the success and long term sustainability of efforts to implement the change in the free care policy. Building support from both health and education decision makers and allies at the state and local levels will help ensure the success of efforts to change a state’s Medicaid plan or state laws related to school health services.

Build for the long term

In order to ensure the long-term sustainability of efforts to expand access to and billing for school health services under the change in the free care policy, it is important to evaluate the impact of the new program. This evaluation should include an assessment of the impact on health and education outcomes. Key indicators to evaluate might include rates of chronic absenteeism (the percent of students missing 10 percent or more of school days for any reason, excused or unexcused), percent of students returning to class after visiting a school health provider and the number and type of health services delivered by school health providers. An assessment of student health needs should also be conducted periodically to determine if additional health services need to be added to the school health service delivery model.

The change in the free care policy presents a tremendous opportunity to increase access to school health services and support the goals of the health and education sectors. We hope our guide can serve as a tool to support stakeholders in leveraging this change to support student health and success.