Importance of School Health Services
Increasingly, schools are seen as the ideal setting to achieve many fundamental healthcare objectives, such as early prevention, chronic disease management and improved quality of care.
Schools are often the primary source of healthcare for children in underserved communities, providing an array of services from comprehensive health screenings to mental health counseling. Access to school-based health services has been shown to reduce health disparities and improve school attendance and academic outcomes.
Yet many inequities exist; more than half of all public schools do not have a full-time nurse or school counselor, and less than 5 percent of students have access to services through a school-based health center.
Expanding School Medicaid
Healthy Schools Campaign is a leader in advancing public policy and advocating for sustainable funding to improve health equity and support healthy school environments.
A key piece of the funding equation is expanding school Medicaid. Since 2016, HSC has led the Healthy Students, Promising Futures (HSPF) Learning Collaborative to help states and school districts implement best practices to maximize federal reimbursement and reinvest in school health services.
HSC works to:
- Assist policymakers in understanding how existing state laws might limit Medicaid reimbursement for school health, and how to implement strategies to expand school-based Medicaid programs.
- Advise state public health departments and education agencies on how to assess the leading health issues affecting students, and how to ensure that needed health services are Medicaid-reimbursable.
- Recommend ways that federal agencies can offer support, technical assistance and replicable models to states and school districts.
Diversifying the School Health Pipeline
HSC connects this work with the need to increase school health staffing and develop a diverse workforce pipeline to ensure students have access to culturally and linguistically responsive health personnel and services. Resources, successful state strategies and federal funding opportunities are available here.
Fostering Cross-Sector Partnerships
In addition, HSC works closely with education, healthcare and public health partners to build and sustain cross-sector endeavors aimed at improving student health.
In partnership with the Public Health Institute of Metropolitan Chicago, HSC manages the Chicago School Health Access Collaborative, which connects Chicago Public Schools officials, advocacy organizations, and health providers and payers to coordinate care, remove barriers to cooperation and facilitate data sharing.
School Medicaid Expansion Progress
HSC advocated for the 2014 federal policy change permitting school districts to seek Medicaid reimbursement for all eligible school health services provided to all children enrolled in Medicaid, instead of being limited to services included in a student’s Individualized Education Plan (IEP).
As of October 2023, more than two dozen states have expanded their school Medicaid program, increasing access to health services for more than 15 million children.
HSC provides direct support to a majority of these states, many of which are members of the Healthy Students, Promising Futures (HSPF) Learning Collaborative, and maintains a state activity tracker and interactive map showing each state’s progress.
States that have expanded their school Medicaid programs have seen an increase in sustainable federal revenue for states and school districts. The success of five states is highlighted in a brief on the financial impact of expanding school Medicaid.
Support for Illinois School Districts
HSC led a successful advocacy campaign in its home state, urging Illinois to amend its state Medicaid plan so school districts could receive federal Medicaid dollars for additional health services and providers. Illinois received federal approval in 2023. More information is available in this FAQ.
To assist schools with expanding billing, HSC led the Medicaid Expansion for School Health Learning Collaborative, providing free training, technical assistance and peer-learning opportunities to 22 Illinois school districts, including Chicago Public Schools (CPS).
Based on this experience, HSC developed recommendations to support statewide implementation of the expanded school Medicaid program and continues to work closely with the Illinois Department of Healthcare & Family Services, the State Board of Education and other partner organizations.
Publications & Other Resources
HSC addresses the interest schools have in Medicaid financing and the challenges they face in navigating payment requirements and coordinating with Medicaid systems. Visit Healthy Students, Promising Futures for additional information.
Diversifying and Expanding the School Health Pipeline
Dr. Kimá Joy Taylor, an expert on health policy, public health and racial disparities, spoke with HSC’s national program director, Jessie Mandle, on ways to diversify and expand the school health pipeline. Their conversations are supplemented by related slides, resources, policy recommendations, federal funding opportunities and state examples.
School Medicaid Expansion: How (and How Many) States Have Taken Action to Increase School Health Access and Funding
As of October 2023, 25 states have expanded their school Medicaid program to cover services outside of an IEP/IFSP. This brief summarizes the policy changes each state made and provides state documents that may be helpful to other states working to increase access to and funding for physical, behavioral and mental school-based health services.
School Medicaid Guidance: What Advocates and State Policymakers Need to Know
This brief answers key questions about the school Medicaid guidance released in 2023 by the Centers for Medicare and Medicaid Services (CMS). It highlights what policymakers and advocates need to know — and how to get involved — to ensure states are best positioned to leverage federal opportunities to increase children’s access to the services they need.
School Medicaid Matters Webinar Series
HSC hosted a three-part webinar series in 2023 with Georgetown Center for Children and Families and Community Catalyst featuring school Medicaid policy experts and school health leaders and advocates. Recordings are available, along with related slide presentations and other resources.
State Policy Opportunities: Advancing Comprehensive School Mental Health Systems to Support Students
Co-published with Mental Health America, this report aims to help state leaders understand their role, as well as the urgency, in addressing student mental health needs. The specific recommendations, and the numerous state examples and resources provided, identify policy opportunities for states to advance comprehensive school mental health (CSMH) systems.
Preliminary Discussion: School Medicaid Guidance Coverage Provisions
This memo assesses the school Medicaid guidance released in 2023 by CMS and also draws from CMS’ August 2022 Informational Bulletin. It offers an initial assessment of how states could move forward to expand and enhance their school Medicaid programs.
A Guide to Expanding Medicaid-Funded School Health Services
This comprehensive, step-by-step guide provides background on school-based Medicaid and outlines various opportunities to advance state policy changes required to access federal funds. Updated in 2022.
Documenting Medical Necessity Through Plans of Care
The policy brief explains the importance of using a plan of care to document medical necessity, which is required for all school health services submitted for Medicaid reimbursement, and offers guidance on implementing plans of care for students without an IEP or 504 plan.
Expansion of School Medicaid Programs: An Opportunity to Ensure Qualified School Health Providers Are Medicaid-Eligible
In order to encourage school districts to maximize resources for school-based healthcare, state Medicaid programs must ensure that school healthcare providers are eligible for Medicaid reimbursement. This policy brief explains how states can resolve identifying school health personnel as Medicaid-qualified providers and shows how six states improved alignment.
Medicaid Coverage of Crisis Intervention Services in a School Setting
This brief considers the circumstances under which school districts can bill their state Medicaid program for sudden and acute mental health crises that students may experience.
Case Studies: How States Are Expanding School Health Services Using Medicaid
These case studies reflect the work states have completed, and the success they have achieved, in leveraging federal Medicaid policy to expand physical, behavioral, and mental health services.
Supporting Child and Student Social, Emotional, Behavioral, and Mental Health Needs
This U.S. Department of Education report provides information and resources on promoting mental health and social-emotional well-being among students. It specifically mentions Medicaid expansion opportunities.