Increasing Access for Mental Health Services in Schools

By Rochelle Davis, President + CEO

When schools reopen, it’s likely that things will look a little different. There are many questions about when and how, but one thing is clear: Students will need access to critical mental health services to deal with the trauma stemming from the COVID-19 crisis.

We know that trauma and anxiety impact learning. We also know that increasing access to school health services presents an important opportunity to reach vulnerable and underserved children and support children’s health and achievement. Regular access to mental and physical health services in schools makes kids healthier, improves attendance and is associated with better academic outcomes, particularly for the most vulnerable students.

However, states can take action to increase resources for behavioral and mental health services to deal with trauma and anxiety. We have been working on increasing access to school health services for the past 10 years, but we have seen momentum pick up recently as our nation realizes the important role schools play in providing health services to students.

In December 2014, a national policy change allowed school districts to bill Medicaid for eligible school health services. However, most states needed to change their state Medicaid program to take advantage of the change. Now, five years later, significant momentum is building. Twelve states—California, Colorado, Connecticut, Kentucky, Louisiana, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, North Carolina and South Carolina—have successfully expanded their school-based Medicaid programs (five of them since August 2019 alone), with more states working to do so.

In the past year alone, we have provided counsel to 15 states and 20 school districts working to increase access to school health services by leveraging Medicaid funding. A significant number of states have expressed interest in expanding their programs to increase access to behavioral health services to address unmet mental health needs.

Last month, we virtually convened more than 150 school health leaders as part of our Healthy Students, Promising Futures learning collaborative to talk about progress they’ve made at the state level in expanding school health services and how to continue to move the work forward. A major focus of discussion was how states and school districts are working to provide students with the health services that they receive in schools while schools buildings are closed.

It is amazing to see how state agencies and school districts can and are working together to make this happen. For example, many states—including Massachusetts, Michigan, New Hampshire, Ohio, Oregon and Virginia—have recently implemented telehealth rules in response to school closures that allow a wide range of practitioners, including school health providers, to deliver and bill Medicaid for telehealth services.

In the nine months since this group last convened, five states received approval to expand their school Medicaid program. This includes California, which received approval to expand their school Medicaid program the week of the meeting—something they had been waiting four and a half years for. We worked directly with the California team and are so excited about this milestone. This approval is a testament to the momentum building around this work and increased support at the federal and state levels.

The COVID-19 crisis has highlighted in a new way the importance of school health services, especially mental health services. While the crisis will pass, the critical role schools play in providing healthcare will be more important than ever. We have an opportunity now to take stock of what has happened over the last several months and think about how we can support some of these changes moving forward to ensure students have access to the health services they need now and when schools reopen.