What States Have Learned Through our Learning Collaborative

November 21, 2016

Earlier this summer, 10 trailblazing state teams participated in a day-long, deep dive at the first in-person meeting of the Healthy Students, Promising Futures Learning Collaborative. The Collaborative is supported by the U.S. Department of Education, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services, in partnership with Healthy Schools Campaign (HSC) and Trust for America’s Health (TFAH).

The meeting of the Learning Collaborative focused on developing state-level strategies for expanding access to school health services through Medicaid reimbursement in order to improve the health and academic achievement of low-income students. The framework for this conversation was based on HSC’s Stakeholder Guide to Implementing the Free Care Rule, which provides concrete steps key decision makers and advocates can take to analyze their current school health services environment and identify opportunities for improving it. State teams walked through this framework and began to develop their own vision for expanding access to school health services and a strategy for enacting this vision.

This month, the states participated in a “check in” to talk about their progress, successes and challenges. While each state’s experience is unique and driven by a number of critical local factors, a number of key themes were universal.

Building Partnerships to Improve Student Health
States want to improve student health and academic achievement and increase the availability and quality of school-based services. Accomplishing these goals at scale, however, requires strong partnerships between education and health stakeholders at the state and local levels. Partnerships can help facilitate important conversations among leaders that result in meaningful data sharing and needs assessments. States said that discussion and coordination between ED (state, district and school level) and Medicaid is critical to success. Several states said that this was the first time cross-agency coordination had taken place on the free care policy or school health generally. But states identified challenges in building partnerships between agencies and getting the necessary internal support to move an agenda forward.

Identifying the Universe of Possible Options to Support Student Health and Academic Achievement
States are considering a wide menu of policy options and delivery models, particularly expanding services through Medicaid. Delivery models include school nurses, specialized instructional support personnel, partnerships with providers ranging from hospitals to community and behavioral health centers to medical schools, and school-based health centers. States have identified innovative delivery models such as mobile or telehealth. Many states expressed a desire to enhance services for specific populations of students, particularly those with chronic diseases that require ongoing management during the school day. Most states identified the need to increase access to behavioral health services in the school setting.

Interpreting CMS Guidance
States identified challenges in designing and implementing an expansion of school-based services. States required to submit a state plan amendment (SPA) identified a desire for guidance on issues including billing and reimbursement, credentialing, benefit design and process. States suggested that additional guidance from CMS would be helpful as they consider their strategic options for expanding access to school-based health services.

Defining Role of Managed Care
The vast majority of states have high rates of managed care penetration and need to better understand managed care and the various options for expanding school-based services. This was particularly true for behavioral health services. States face challenges understanding provider contracting and certification, in-network requirements as providers, options for reimbursement under managed care arrangements, and other benefit and design issues. Some states are pursuing conversations with managed care organizations to discuss potential partnerships and seek guidance from CMS on best practices for pursuing school-based Medicaid services when students are enrolled in managed care.

Assessing Community and Needs
All states clearly identified the need to better identify what services are currently being provided in schools and how, the type and estimated size of the unmet student needs and where to prioritize specific services and providers. Some states have identified sources of relevant data or other community-level partners to help collect and analyze data. However, all states have identified that data sources are inconsistent and/or difficult to find and would like technical assistance in this area.  While needs assessments required under ESSA were raised as a key opportunity for incorporating health, technical assistance is needed to develop needs assessment processes that effectively incorporate a focus on student health.

Expanding Partners and Improving Transparency
State teams identified the need to expand outreach to Local Educational Agencies (LEAs) to increase school participation in both the needs assessment process and, eventually, in implementation and continuous improvement of high-impact school-based health services. Most states identified the need for strong local partner relationships with health providers, managed care, state-level associations and advocates. However, few states have strong mechanisms in place to build these coalitions.

The experience with the HSPF Learning Collaborative—and the focus on cross-agency coordination—was a positive contribution to the members of the state teams. They all continue to focus on improving student health through Medicaid and bring to their states a range of ideas and best practices. In fact, the Collaborative has been so well-received, additional states have asked to participate.

The Department of Education, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services, HSC and TFAH remain committed to the success of the Learning Collaborative. In addition to providing resources and webinars to the state teams to support their learning, we also continue to partner with a wide range of national organizations that provide invaluable technical assistance and support directly to the state teams.