State and Local Action Steps and Practices to Improve School-Based Health
High-Impact Opportunity #2: Provide and Expand Reimbursable Health Services in Schools.
Schools and LEAs may be eligible, subject to an approved state Medicaid plan, for reimbursement for Medicaid services delivered in schools to children enrolled in Medicaid. Recent guidance from the Centers for Medicare and Medicaid Services (CMS) explains changes in the federal "free care" policy, which addresses Medicaid payment for services available without charge to the community at large ("free care"). Schools and LEAs can refer to this guidance to understand the requirements that must be met in order for Medicaid reimbursement to be available.
Research shows that services provided by school-based health centers can significantly improve key educational outcomes among students.
State Medicaid agencies, State educational agencies (SEAs), and LEAs can work together to explore opportunities to secure reimbursement for health services delivered to students enrolled in Medicaid. They can map out a plan for making sure that schools with large numbers of eligible students are equipped to participate.
Hanover County Public Schools in Virginia is able to claim Medicaid reimbursement for services delivered to children enrolled in Medicaid. The funds received by the state go back to the school district and are used for special education and health services programs. The funding supports several nursing positions as well as contracted nursing services for students who require one-on-one care. It also supports the purchase of large equipment for occupational therapy, physical therapy and vision and hearing services, as well as school clinic supplies such as medicine cabinets, thermometers, nebulizers, suction machines, wheelchairs, cots, and other supplies.
- To learn about the preventive, dental, mental health, and developmental/specialty services available through Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for children, visit http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html.
- To get resources and information related to preventive services for individuals enrolled in Medicaid or CHIP, visit http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prevention.html.
- To learn about the Medicaid Free Care Policy and what it means for delivering health services to students at school, visit http://www.medicaid.gov/federal-policy-guidance/downloads/smd-medicaid-payment-for-services-provided-without-charge-free-care.pdf.