社区黑料

Get stories like this delivered straight to your inbox. Sign up for 社区黑料 Newsletter

Schools are places where health care happens, an essential part of the nation鈥檚 public health infrastructure. During COVID-19, schools across the country responded to the to vaccinate students and community members and to provide nutritious meals and to kids 鈥� despite shuttered classrooms. Even before the pandemic, schools were providing care that supports classroom learning to the children who have special health care needs, including those with chronic physical, developmental, behavioral or emotional conditions. 

A recent study in JAMA Pediatrics found that schools are 鈥�,鈥� providing services to 57% of adolescents who needed care before the pandemic. In 2019, found 37% of high school students reported persistent feelings of sadness or hopelessness; 19% having seriously considered suicide; and 9% having attempted suicide. And the need is even more profound now. From April to October 2021, the proportion of pediatric emergency room visits that were mental health-related increased nearly a third for ages 12 to 17 and 24% for children aged 5 to 11. 

As is always the challenge in public education, the need far outweighs the resources available. But changes in federal Medicaid payment policy have paved the way for schools to access millions of dollars to fund school nursing, behavioral health and other services in schools.

For example, in 2014, the Centers for Medicare and Medicaid Services broadened a longstanding to allow schools to be reimbursed for providing covered services to any Medicaid-eligible child. But only have taken advantage of this funding stream by amending their Medicaid state plans (the document that defines the types of services and providers that are eligible for reimbursement) to reflect the new policy. 

Michigan to include behavioral health analysts, school social workers and school psychologists as covered providers, while the state legislature approved $31 million to fund behavioral health providers in schools. Since this change, there has been about a in the amount of Medicaid reimbursement being directed to schools. Louisiana amended its Medicaid state plan in 2015 and saw a 30% increase in its Medicaid revenue as the school nursing workforce . Last year, Georgia changed its plan to allow Medicaid to pay for more school health services. are covered by Medicaid or the state’s PeachCare system, so this shift is dramatic and creates an opportunity to bring hundreds of millions of dollars to Georgia鈥檚 school districts to support the most vulnerable students.

More states can position themselves to leverage Medicaid funding for schools by clarifying and expanding the scope of covered school health services and providers in their state Medicaid plans. But, some schools face additional barriers, such as complex billing processes. That issue is being addressed in the , which directs federal policymakers to issue guidance, launch a help center and release $50 million in planning grants in the next 12 months to assist state Medicaid agencies and local educational entities in overcoming these challenges. These supports are likely to include strategies and tools to reduce administrative burdens for billing, especially for rural schools, and best practices that schools and state Medicaid agencies can use to amend state plans so the services students need, and the providers who deliver them, become eligible for reimbursement by Medicaid.

The National Healthy Schools Collaborative鈥檚 prioritizes optimizing the ability of schools to bill Medicaid for school health services and, importantly, recognizes that when health and education officials fail to collaborate, it makes it very difficult to achieve this end. School nurses, district administrators and state education officials must get ready to collaborate with state Medicaid agencies to take advantage of supports the act will provide 鈥�  preparing data on the health needs of their school communities, the types of services provided in schools (and that schools could start providing if reimbursed) and the types of licenses and credentials required for personnel delivering services in schools. State Medicaid officials can then make sure state plan amendments reflect the exact types of services students need and that schools are capable of delivering.

How else can school nurses, district administrators, and state education officials prepare?

• which states reimburse for Medicaid. Share information about the forthcoming supports for increasing access to Medicaid funds for school health services and providers.
• Engage with school or district to collect community input on the health services they want to access, understand school communities’ unmet health needs and increase awareness of the availability of Medicaid services in school.
• Review the from local hospitals to further understand the significant health needs of the community and the resources available to address those needs.
• Make connections at the and advocate for reimbursing school providers for specific services (e.g., counseling, personal care, case management, immunizations) that are a priority for students.

Did you use this article in your work?

We鈥檇 love to hear how 社区黑料鈥檚 reporting is helping educators, researchers, and policymakers.