A Guide to Expanding Medicaid-Funded School Health Services

A Guide to Expanding Medicaid-Funded School Health Services


December 2019

This guide provides background on school-based Medicaid and outlines various opportunities to advance state policy changes required to access federal funds. This guide provides a unique glimpse into building a sustainable funding structure and offers concrete lessons for collaboration among agencies.

This guide is designed to support people at the national, state and local levels who are working to improve student health and educational outcomes. To do this, we build on the incredible work being done across the country to expand access to and resources for school health services—and the state policies that promote these efforts.


The Challenge

Today, 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. These health issues can have a significant impact on children’s long-term health as well as their opportunities to learn. In addition, students in underserved communities, particularly students of color, are at increased risk of these chronic health problems.

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


The Opportunity

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


Who Is This Guide For?

This guide is designed to support everyone working to expand access to school health services that are paid through Medicaid, including state and local education agency staff, state Medicaid agencies, school health providers, public health professionals and advocates. All of these stakeholders share a common goal: improve student health and educational outcomes.

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.

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.

Creating a Supportive Environment for Reinvestment in School Health

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.

September 2020

Understanding the Financial Impact of Expanding Medicaid Funded School Health Services in Colorado

Building Cross-Sector Collaboration to Support School Behavioral Health Services: Washington’s Children’s Regional Behavioral Health Pilot Program

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