Medicaid Expansion for School Health

Medicaid Expansion for School Health

Illinois School Medicaid Expansion

In 2021, the Illinois Department of Healthcare and Family Services (HFS) submitted a state plan amendment (SPA) to expand the state’s school-based Medicaid program.

Approved in April of 2023 (and retroactive to July 1, 2021), the amendment allows Illinois school districts to bill for eligible health services provided to all students enrolled in Medicaid, adds additional Medicaid-eligible services and providers, and transitions the state’s school Medicaid program to a cost settlement model. (Read HSC’s press release and learn more about the SPA in this FAQ.)

To support school districts in taking advantage of this opportunity for additional reimbursement, Healthy Schools Campaign launched the Medicaid Expansion for School Health (MESH) Learning Collaborative in October of 2021.

Supporting Illinois School Districts

Through the MESH Collaborative, HSC provided free training, technical assistance and peer-learning opportunities to assist school districts in expanding Medicaid billing for school health services and using the additional funds to provide new services and supports for students. HSC also developed a framework and step-by-step guidance on Medicaid billing and resources to assist districts with Medicaid outreach.

Over a two-year period, 22 Illinois school districts with a combined enrollment of more than 400,000 students participated in MESH.

Based on this experience, HSC developed recommendations for state agencies and other partner organizations to support statewide implementation of the SPA.

Participating Districts

Cohort 1
Addison School District 4
Ball Chatham #5
Chicago Public Schools
Community High School District #117
Consolidated High School District #230
Granite City CUSD #9
Huntley Community School District #158
Keeneyville School District #20
North Chicago School District #187
Wheeling Community Consolidated School District #21

Cohort 2
Eldorado CUSD #4
Evanston/Skokie School District #65
Galesburg CUSD #205
Jasper County Schools #1
Lake Villa School District #41
Marquardt School District #15
Morton Unit School District #709
Olympia CUSD #16
Paris Union School District #95
Rockford Public Schools #205
Sandwich CUSD #430
West Chicago Elementary School District #33

Advisory Committee Members
EverThrive Illinois
Illinois Alliance of Administrators of Special Education
Illinois Association of School Business Officials
Illinois Association of School Nurses
Illinois School Counselor Association
Illinois School Psychologists Association
National Association of School Social Workers, Illinois Chapter

Illinois School Medicaid Billing & Reimbursement Process

Healthy Schools Campaign created the Guide to Illinois School Medicaid Billing and Reimbursement to assist school districts in navigating the school Medicaid program and in developing streamlined processes and procedures to maximize reimbursement, ensure compliance, and ultimately increase the availability and quality of health services for students. For detailed guidance on implementing each step in the reimbursement process, click on the links in the flowchart or view the Reimbursement Process Guidance documents below.

More Information

Reimbursement Process Guidance

Additional Resources

This guidance is intended to assist school districts with improving and expanding Medicaid reimbursement for school health services. It should not be construed as legal advice. The information is accurate to the best of our knowledge as of August 2023, based on a review of publicly available guidance from the Illinois Department of Healthcare and Family Services (HFS) and its partner Public Consulting Group (PCG), and discussions with subject matter experts. School Medicaid requirements are subject to change. Please refer to the most recent guidance from HFS and PCG.

School Medicaid Resources

This section features policy briefs, guidance and other school Medicaid resources developed by Healthy Schools Campaign, followed by Illinois state agency resources and websites.

HSC Publications

Illinois State Agency Resources