Introduction
With the federal government's 2023 release of updated school Medicaid guidance, there is a unique opportunity to leverage Medicaid as a sustainable funding source for school health services. However, the complexity of the program can be challenging. This blog aims to equip education agency staff, school-based providers, and other partners with a comprehensive understanding of Medicaid in schools.
What is Medicaid?
Medicaid, along with the Children's Health Insurance Program (CHIP), provides low- or no-cost health insurance to individuals and families with low incomes, including nearly 40% of all children. It offers a comprehensive benefit package covering preventive care, treatment, and services to address physical, mental, and behavioral health concerns.
Medicaid's Role in Schools
Medicaid plays a critical role in schools by funding health services for students. School-based health services are essential for addressing chronic health issues that can affect students' academic performance. Since 1988, Medicaid has supported health services included in a student's Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP).
What Does School Medicaid Cover?
Each state's Medicaid plan defines the coverage for school-based services. To be reimbursed, the student, service, and provider must be eligible under the state plan. Eligible services often include nursing, therapy, and mental health counseling. Administrative services like care coordination and enrollment support can also be reimbursed.
Reimbursement Process
School districts are reimbursed for Medicaid services through methods like fee-for-service or cost settlement. The reimbursement is a sustainable funding source for services that would otherwise be paid for with district dollars. In some states, districts must contract with Medicaid managed care organizations (MCOs) for reimbursement.
Utilizing Medicaid Reimbursement Funds
School districts use Medicaid reimbursement to support health provider salaries, expand services, and facilitate outreach. Funds may also be reinvested in equipment, professional development, and special education programming. Some states encourage districts to reinvest these funds in school health services.
Questions to Ask
- What percentage of students in the state are eligible for Medicaid?
- What does the current state Medicaid plan say about school health services?
- Has the state expanded school Medicaid to cover all eligible services?
- How are districts reimbursed for Medicaid services?
Additional Resources
For more detailed information, you can access resources like the CMS Guidance on Medicaid in Schools and the Medicaid Information Toolkit by AASA. Visit Healthy Students, Promising Futures for more insights.
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