25 states and DC cannot use or face barriers when trying to use Medicaid for school health services

December 14, 2020

CORRECTION: This press release has been updated to correct the number of states that cannot use, or face barriers when trying to use, Medicaid to provide free school-based health services. The original press release put this number at 27 states and DC. After accounting for an updated policy analysis, the correct number is 25 states and DC.

A new analysis finds that schools in 25 states and the District of Columbia cannot use, or face barriers when trying to use, Medicaid to provide free school-based health services, despite a 2014 policy shift that aimed to make it easier to bill Medicaid for these services. According to Early Evidence of Medicaid’s Important Role in School-based Health Services, these barriers prevent schools from employing school nurses or counseling staff to provide audio and visual screenings or establishing school-based health centers. Access to these services have become more critical since the onset of the COVID-19 pandemic.

“Every child deserves to be healthy. Unfortunately, too many children have unmet health needs, especially Black and Brown children and children in low income households,” said Andra Wilkinson, a Child Trends health equity expert and lead author of the report. “Schools are critical partners in delivering health care because they see all children and because health is essential for learning. Our study helps local and state decisionmakers understand what resources are available to support school-based health services.”

Until 2014, Medicaid policy prevented schools from obtaining reimbursement for services provided to students enrolled in Medicaid if those services were available without charge. After the Centers for Medicare and Medicaid Services lifted these restrictions, nearly a dozen states have taken steps to expand Medicaid reimbursement for school-based health services.

While state Medicaid expenditures on school-based health services increased from 2010 to 2018, the analysis shows that the 2014 policy change has not yet resulted in large increases. This was true even in states whose State Medicaid Plans do not prevent schools from billing Medicaid for school-based health services.

“It’s possible that it is too early in the implementation of these new practices for states to see a huge uptick in spending,” said Wilkinson. “What’s clear is that state leaders are motivated to take advantage of this opportunity to improve access to health care, particularly behavioral and mental health services. Those we spoke with are taking important steps to engage stakeholders and manage the logistics of this policy shift.”

Based on conversations with state and district leaders, the authors offer recommendations for states interested in expanding Medicaid reimbursement for school-based health services. States should engage leaders from health and education agencies early in the process, and also build relationships with community and advocacy organizations to understand the challenges they face.  States should also allow time for training, buy-in and implementation as well as reach out to the Centers for Medicare and Medicaid Services for guidance as needed.