Making Progress on the Free Care Policy

November 03, 2015 | Written By:

Last December, the Centers for Medicare & Medicaid Services (CMS) removed a key barrier to funding school health services. CMS issued “guidance” stating that the so-called “free care” policy does not apply to schools, which means that schools may receive reimbursement funding from Medicaid for health services provided to Medicaid-eligible students.

Healthy Schools Campaign and other advocates across the country fought long and hard for this important change, and we were excited that our voices were heard. But the fight is far from over. Now, we’re fighting to make sure the full impact of this change is realized. While the change in the free care policy was an important step towards ensuring that students have better access to health services, there is still a lot of work to be done.

Over the past 10 months, we have been meeting with advocates, stakeholders and policymakers to learn more about what it will take to successfully implement the recent change in the free care policy and allow schools to start billing Medicaid for eligible care.

In June, Healthy Schools Campaign and Trust for America’s Health convened a meeting of more than 30 individuals—including school Medicaid experts, advocates, federal policy makers and school district representatives—to discuss how to leverage this recent policy change to increase access to school health services.

Through this work, we have learned:

  • Implementation of the free care policy will vary by state. 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. Since each state’s Medicaid plan is different, the amendments to each state plan will also be different. 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.
  • We need to spread the word. There is an important need to educate school stakeholders, policy makers, health care providers and others about the change in the free care policy and the potential impact it can have on improving student health. Through our work we have learned that there are many key individuals who are unaware of what the free care policy was and how it was changed. We encourage you to spread the word by having conversations about the need for increased access to health services and sharing resources such as blogs we have published in the past here and here.
  • We are making progress. We know that there are many states across the country that are working to make sure the opportunity presented by this recent policy change is not missed. For example, California recently passed a lawthat requires their state Medicaid agency to implement the change in the free care rule. Efforts are also taking place in Louisiana, Massachusetts, Washington State, Minnesota, Colorado and Illinois to use this recent change to increase access to school health services. If you are aware of additional states that are working on this issue please share them with us.

We continue to work toward our vision of ensuring students across the country have regular access to school health services and believe the guidance from CMS regarding the free care policy is a key step towards achieving this vision. We encourage each of you to speak to your local school district, state representative, PTA and others about this change and what it can mean for children’s health. We look forward to continuing to work with advocates across the country increase access to resources for school health services.

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