How to Expand Medicaid-Funded School Health Services

Healthy Schools Campaign has published a policy brief on expanding access to—and resources for—school health services using available Medicaid funds. The brief provides an accessible overview of student health needs and the work to be done at state and local levels to leverage available funding for physical and mental health services.

HSC also has prepared a comprehensive guide to help states expand school-based health services and align their state Medicaid policies with guidance issued by the Center for Medicare & Medicaid Services.

The Case for School-Based Medicaid Expansion

One in four children in the United States has chronic physical or mental health issues that affect their ability to succeed in the classroom, double the number just 30 years ago. Left untreated or undermanaged, health issues can adversely affect children’s attendance, their ability to see, hear and pay attention in the classroom, their ability and motivation to learn, and even their chances of graduating from high school.

In addition, students in underserved communities, particularly students of color, are at increased risk of chronic health problems such as diabetes and asthma that can hinder learning and have a significant impact on long-term health.

Evidence has shown that school-based health services are essential to addressing these concerns. Studies also show that access to school health providers improves health and academic outcomes, particularly for students with chronic health issues, and reduces health care costs overall.

CMS Presents an Opportunity for States

In December 2014, the Centers for Medicare and Medicaid Services (CMS) clarified which health services can be reimbursed by Medicaid in a school-based setting. This guidance allows school districts to increase access to physical and behavioral health services for more students.

As of early 2020, 10 states—Connecticut, Kentucky, Louisiana, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, North Carolina and South Carolina—have successfully expanded their school-based Medicaid programs (four of them in 2019 alone), with more states working to do so. There is an especially strong interest in leveraging the opportunity to support mental health services. Read more about state efforts here.

However, CMS presented an opportunity, not a mandate. As a result, there is a critical need to support states in implementing the current CMS policy and allowing school districts to seek reimbursement for additional school health services.

Schools Are Key to Improving Children’s Health

This brief (January 2020) focuses on how to improve children’s physical and behavioral health through the expansion of school-based health services.

It provides an accessible overview of student health needs and the work to be done at state and local levels to leverage available funding for physical and mental health services.


A Guide to Expanding Medicaid-Funded School Health Services

This guide (December 2019) provides background on school-based Medicaid and outlines multiple opportunities to advance state policy changes required to access federal funds.

It provides a unique glimpse into building a sustainable funding structure and offers concrete lessons for collaboration among agencies.


Guide Sections

Getting Started: Understanding the Medicaid Landscape

Medicaid provides a significant amount of funding in almost every state for school health services. State eligibility and benefits vary based on factors and policies unique to each state.

Download Section One

Getting Started: Understanding the School Health Landscape

In order to improve school health services, it is important to know what services are already provided in your state, where there are gaps and unmet needs, and if and how they are reimbursed by Medicaid.

Download Section Two

Getting Started: Building a Coalition to Expand School-Based Health Services

Many different participants are involved in developing and implementing policy on expanding school-based health services—and the policies affect an even broader circle of people.

Download Section Three

Opportunity: Creating a Supportive Environment for Reinvestment in School Health

States and school districts have ownership over many decisions that are critical to ensuring that the school Medicaid program supports student health and wellness.

Download Section Four

Opportunity: Streamlining and Implementing Policies to Facilitate Medicaid Reimbursement

Implementing a successful school-based Medicaid-reimbursement program can help school districts stretch limited resources to support their school health programs.

Download Section Five

Opportunity: Expanding School-Based Medicaid Programs Though the “Free Care” Rule

Many states are in the process of (or are considering) expanding school-based Medicaid programs to include all Medicaid-enrolled students—and to add additional covered services and provider types. This presents a tremendous opportunity to expand access to and resources for school health services.

Download Section Six

Opportunity: Working with Medicaid Managed Care Organizations

Understanding the role of Medicaid managed care organizations (MCOs) and thinking about how to strengthen partnerships between schools and MCOs can be a winning strategy for states, school districts and the MCOs themselves.

Download Section Seven

Opportunity: Untangling HIPAA & FERPA

Communication among all members of the care team is critical to making sure students get the health services they need—but it can be challenging to share healthcare and education data while navigating federal and state privacy rules.

Download Section Eight

Opportunity: Building Partnerships to Expand Access to School Health Services

Partnerships can play an essential role in addressing student health needs and expanding access to student health services. Identifying and engaging potential partners in your state and community is key to ensuring access to care for vulnerable students.

Download Section Nine

How to Evaluate Progress

As states across the country move forward with making major changes to their school-based Medicaid programs, it’s essential to evaluate the impact of these changes on both health and academic outcomes.

Download Section Ten