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Medicaid reimbursement funding for health services provides schools with a reliable source of sustainable revenue. Schools that have taken advantage of these funds have reported that the access to care for students enrolled in Medicaid has expanded. The quality of care that schools can provide to all students has also improved thanks to reimbursement funds.
Your school is legally required to provide certain health services to students. Most schools aren't taking advantage of Medicaid reimbursements – an important source of funding – for the provision of these services, because the process seems daunting, complex, and time-consuming.
Due to lack of funding to support school-based health services, more than half of public schools do not have a full-time school nurse or counselor, and less than 5% of students have access to services through a school-based health center.
Not billing Medicaid for eligible health services that are already being provided in schools means that you're leaving hundreds of thousands of federal dollars unclaimed. Federal funds can be used to increase provider capacity, add additional services, or plug budget holes to keep school health services strong. Ultimately, this will help your school to expand your staff for physical and behavioral health services to students.
Good student health translates to better student performance.
It's hard to deny that there's a direct correlation between a child’s health and their readiness to learn. Untreated, improperly handled, or under-managed student health issues affect children’s attendance rates. It also disturbs their ability to see, hear, and pay attention in the classroom, their ability and/or motivation to learn, and – ultimately – their chances of graduating.
According to a 2020 report from the "Healthy Schools Campaign," one in four school-aged children in the United States has chronic physical or mental health issues that directly interfere with their ability to succeed in the classroom.
Numerous studies also show that access to school nurses and other school health providers can improve health and reduce absenteeism – especially for students with chronic issues.
During the past few decades, public health research has documented the effects of various social determinants of health – especially about the interactive effects of health, education, and future success. Your school materially influences both your students' health and education outcomes.
In December of 2014, the Centers for Medicare and Medicaid Services (CMS) expanded the list of reimbursement-eligible services – both on and off-site – to include healthcare services from school nurses, speech therapists, mental health providers, other medical specialists, and more.
Previously, only health services that were delivered under a student’s Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP) were eligible for reimbursement funding from Medicaid. Now, CMS is willing to provide reimbursement for all eligible services delivered to any Medicaid-enrolled student while in school.
As of February 2020, only ten states – Connecticut, Kentucky, Louisiana, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, North Carolina, and South Carolina – had successfully expanded their school-based Medicaid programs to include this expanded list of eligible services from Medicaid.
If your school is not within one of these states – don't despair!
More states are actively working to change over to the new policy. In the interim, you can bill Medicaid for the health services that you're already providing to students with IEP's and IFSP's.