Illinois Moves to Expand School Health Services

The Illinois Department of Health and Family Services (HFS) took a crucial step this fall toward improving healthcare access and health equity for school children: The department amended the state Medicaid plan to allow schools to seek federal reimbursement for eligible health services provided to all children enrolled in Medicaid.

It’s a major shift from the current state policy, which allows billing for healthcare services only if the services are included in a student’s Individualized Education Plan (IEP) — which limits reimbursement to 14 percent of Medicaid-enrolled students. 

Once finalized, school districts will be able to access federal funds for health services delivered to all 800,000 students enrolled in Medicaid, including 235,000 students in Chicago alone. 

The state plan amendment brings Illinois into alignment with the federal Medicaid policy, which opened the door to expanding Medicaid coverage for school health services at the end of 2014. Sixteen states have so far made adjustments to leverage this policy, with more states working to do so (this map developed by Healthy Schools Campaign shows the progress). 

Once the Centers for Medicare & Medicaid Services approves the amendment, which is expected before the end of the 2021-22 school year, the changes will be retroactive to July 1, 2021. It will be a huge win for students and schools, and an important resource and equity issue for all of Illinois.

HSC has long championed Illinois taking this action: We published a policy brief on how Illinois could leverage Medicaid funds for school health services; educated state and school leadership about the benefits; and led an advocacy campaign with the support of dozens of health service providers, hospitals, and health and education advocacy, philanthropy and community-based organizations from across the state.

And now we’re leading a new program, the Medicaid Expansion for School Health Learning Collaborative (MESH), to provide free training, technical assistance and peer learning opportunities to help Ilinois school district teams develop and implement strategies for expanding Medicaid billing for school health services. Eight school districts are currently taking part, including Chicago Public Schools, the state’s largest district. 

The MESH Learning Collaborative will work to create best practices and identify challenges. Their experiences will be shared with other school districts as well as with HFS and the Illinois State Board of Education to inform state policy and practice.

In addition to amending the state plan to allow billing for all medically necessary services outlined in Medicaid’s comprehensive EPSDT benefit, Illinois also updated and added to the list of healthcare providers deemed eligible to bill Medicaid for school-based health services. The comprehensive list now includes behavioral health analysts, licensed clinical professional counselors, and licensed marriage and family therapists.

“HFS considers this an important way to draw down Medicaid dollars, sometimes for services schools are already providing,” Julie Hamos, former HSF director and senior advisor on Medicaid coordination at the Office of Medicaid Innovation, told Illinois school districts during a recent meeting of the MESH Learning Collaborative.

The benefits of expanding school health services through Medicaid are widespread and include:

More information about Illinois school Medicaid policy is available in this updated FAQ. Also learn how other states are benefitting by expanding Medicaid-funded school health services.