The announcement specifically affects the tens of millions of children who receive their health care through Medicaid, but all school-aged children will benefit from the change because the new guidance makes it clear that schools can use Medicaid dollars to hired additional school counselors, nurses and social workers. workers who could handle all students. More than half of children in public schools receive their health care through Medicaid and CHIP programs.
While the guidance applies to both physical and mental health, the Biden administration is emphasizing how much it can help children’s mental health.
“We really have a mental health crisis in our country, especially with our nation’s children. And so the guidance we’re issuing today is really about encouraging states to try to expand access to mental health services for children,” Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure told CNN. “And as part of that we’re reminding states of their obligations to cover mental health services. And we’re encouraging states to work with schools to make sure kids have access to those services.”
The guidance also clarifies a policy change first issued under the Obama administration in 2014, which told schools that Medicaid would pay for any type of health care for any child enrolled in the program. Before the policy change, schools could only bill Medicaid for children enrolled in special education programs. To expand medical services to all children covered by Medicaid, some states had to apply to the federal government, but only 16 states did so.
The guidance issued Thursday should encourage the remaining states to expand this type of school health care access and also expand mental health services for children in general.
“It’s really giving that assurance that yes, from our perspective, schools should be and can receive funding through the Medicaid program to provide mental health services as well as other services to children,” Brooks-LaSure said.
This new approach means schools are guaranteed payment for field staff to provide medical and mental health services. This means that more children should have better access to preventive care such as psychological evaluations, vaccines, counseling and screening services that can ensure that the child can see and hear. The money can also be used to help a child manage their medication or take better care of their asthma.
Before this new guidance, experts say some schools may have been reluctant to offer these services because they were worried they wouldn’t be reimbursed by Medicaid and would have to pay the money out of the school budget. An expense that few schools could afford.
“I think this addresses a number of questions and concerns and issues that will go a long way in giving states and school districts the confidence to move forward,” said Rochelle Davis, president and CEO of the Healthy Schools Campaign, a nonprofit organization. national organization that works with schools to ensure that all children have access to healthy school environments.
Right now students can access some health care in schools, Davis said, but it’s often paid for by the district or philanthropy.
“It’s not sustainable and it doesn’t allow for the comprehensive, coordinated care that’s needed,” Davis said. “This allows schools to have staff at the school and build a sustainable and comprehensive program.”
“Expanded Medicaid funding for school health services is good for students. It’s good for the school and it’s good for public health,” Davis added.
The guidance issued today also clarifies that states cannot place restrictions on mental health services provided to children. For example, states can no longer deny mental health services to children on Medicaid who do not yet have an official mental health diagnosis. Currently, unless a child has a specific diagnosis, experts say it can be challenging for children to access mental health care such as therapy or prescription drugs.
“If I’m working with a young child, it might take a while to decide what the diagnosis is. I want to be able to support that child and I don’t want to wait until something comes up, but there’s been an administrative decision . obstacle there,” said Dr. Marian F. Earls, a pediatrician who serves as chair of the American Pediatric Association’s council on Healthy Mental and Emotional Development. “This is a great first step.”
Earls has seen what removing these administrative barriers can do in her home state of North Carolina. She worked closely with the state director of Medicaid to eliminate the same administrative hurdle and improved children’s access to care almost immediately.
“It was huge. It was huge,” Earls said. “And it really led to the ability of (pediatric) practices in my state to start integrating a mental health professional into their practice.” Having a mental health care professional on staff allowed the practice to care for the child’s physical and mental health.
“It really facilitates early identification and support,” Earls said. Proactively addressing mental health issues can keep kids out of the emergency room with a crisis.
Davis believes the Biden administration’s announcement today could make a big difference in improving this generation of students’ physical and mental health.
“I think it will be transformative,” she added. “And ultimately that’s good for students. It’s good for schools and it’s good for the public because it’s using federal resources very efficiently.”