Kentucky school nurse Eva Stone could tell you exactly where she was standing five years ago when she read a letter from the Centers for Medicare & Medicaid Services (CMS) reversing the so called “free care” rule. “I was managing a district’s health services in rural Kentucky, and we were losing funding for our school nurses,” she says. “For several years, we had been going year to year figuring out how to fund the nurses.”
In December 2014, after years of work by advocates—including Healthy Schools Campaign—-CMS clarified the way that Medicaid would reimburse for health services delivered in schools. School districts, once restricted to reimbursement for services delivered to students enrolled in Medicaid under very specific conditions, were now permitted to cover all eligible services delivered to all Medicaid-enrolled students. Put simply, this meant more health care funding for the most disadvantaged students. For many states, including Kentucky, taking advantage of this opportunity meant changing their state Medicaid plan.
Stone immediately understood what the policy change represented for her district. “This was the opportunity to continue to fund the school nursing program we had,” she says. More than that, the policy change represented an opportunity to increase access to and funding for all health services delivered in schools.
Stone took to Google and came across a webinar featuring HSC’s Senior National Program Director, Alex Mays. She listened to the webinar and got in touch with Mays to learn more about how to progress in Kentucky. (That same year, Stone also won our School Nurse Leadership Award.
Stone got in touch with several key groups, including the Kentucky Youth Advocates and the Kentucky Nurses Association. Through those connections, she began to find like-minded advocates and form a committee for school nursing. Through that group, she began engaging legislators around the opportunity to use Medicaid funds.
The groundwork was laid when in 2018, a legislative taskforce around school safety was formed in response to a school shooting. “When they started talking, it was about arming teachers,” Stone says. “By the time they finished, they were looking at a system of support for mental health for children.”
Based on the work of that taskforce, the School Safety and Resiliency Act was signed into law in spring 2019. That bill laid out specific goals for counselors in schools and mental health services for students but did not provide funding to do so. Amending the state Medicaid plan to take advantage of the policy change was the next step, and the amendment was approved in November 2019. Kentucky is now one of 10 states that have successfully expanded their school-based Medicaid programs through the free care reversal.
Looking back at the process, Stone knows that five years seems like a long time, but she’s satisfied that Kentucky took a comprehensive approach. “Don’t just look at this as an opportunity to bill in schools but think about how you can improve the health of children in your state,” she says. “This isn’t just about schools, it’s about a system of care for children.”
Stone now works at another school district in Kentucky where she says half of the district’s 6th graders don’t have their preventive exams. Implementation of the policy change is ongoing in Kentucky, but Stone has high hopes for the impact it will have on students like hers who don’t have a medical home and can now receive much-needed care at school. “If kids are not healthy, they won’t learn,” she says. “It’s really that basic.”