A Guide to Expanding Medicaid-Funded School Health Services
Revised and Updated: March 2022
Original Publication: December 2019
A Guide to Expanding Medicaid-Funded School Health Services provides background on school-based Medicaid and outlines various opportunities to advance state policy changes required to access federal funds.
In December 2014, the Centers for Medicare and Medicaid Services clarified Medicaid reimbursement in school-based settings, opening the door to more funding. This Guide covers best practices for bringing state Medicaid plans into alignment with federal policy, designing the administrative processes, and tackling other obstacles to improving student access to care. It also covers building a sustainable funding structure and offers concrete lessons for collaboration among agencies.
It is designed for anyone working to expand access to school health services, including state and local education agency staff, state Medicaid agencies, school health providers, public health professionals and children’s health advocates. All of these stakeholders share a common goal: improve student health and educational outcomes.
Plus: Healthy Students Promising Futures, a learning collaborative led by Healthy Schools Campaign, has published case studies reflecting the work, and success, of states leveraging federal Medicaid policy to expand physical, behavioral and mental health services.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.