Medicaid in Schools Guidance Language is Law

June 27, 2022

The bipartisan Safer Communities Act that passed to prevent gun violence last week included language requiring CMS to issue new school-based Medicaid guidance before June 2023. The guidance does EXACTLY what the Medicaid in Schools Coalition has been asking CMS to do for years and goes further than what we had hoped for by providing direct grants to states to start the hard, but meaningful work of changing how they process Medicaid claims, find ways to dramatically expand Medicaid-reimbursable services to schools, and generally take advantage of the new flexibilities that they will be granted via updated guidance to expand healthcare, particularly mental health services, to millions more children.

This is going to be totally game-changing for states, for districts and most importantly for KIDS.

Here are the specifics (which you can also find starting on page 11 here)

  1. Update the Medicaid guidance from 1997 and 2003
  2. Clarify that a State should take steps to allow a district to bill for any EPSDT service they provide
  3. Outline strategies/tools that reduce the administrative burdens on, and simplify billing for local educational agencies, in particular small and rural LEAs, and support compliance with Federal requirements regarding billing, payment, and recordkeeping, including by aligning direct service billing and school-based administrative claiming payments
  4. Include a comprehensive list of best practices and examples of approved methods that State Medicaid agencies and local educational agencies have used to pay for, and increase the availability of, assistance under Medicaid, including expanding  State programs to include all Medicaid-enrolled students, providing early and periodic screening, diagnostic, and treatment  (EPSDT) services in schools, utilizing telehealth, coordinating with community-based mental health and substance use disorder treatment providers and organizations, coordinating with managed care entities, and supporting the provision of culturally competent and trauma-informed care in school settings; and
  5. Provide examples of the types of providers (which may include qualified school health personnel) that States may choose to enroll, deem, or otherwise treat as participating providers for purposes of school-based programs under Medicaid and best practices related to helping such providers enroll in Medicaid for purposes of participating in school-based programs under Medicaid. (note: this is essential for ensuring critical school personnel like school psychologists can bill Medicaid and was NOT something CMS was planning to clarify in their guidance based on our most recent conversations with them).
  6. Create a NEW TA Center—in consultation with ED—with $8m in seed money so districts and states aren’t lost about how to do school-based Medicaid any more. Further, the TA Center has to report to Congress on the areas where the most TA was requested to ensure that CMS is accountable and responsive to stakeholder needs.
  7. $50m in grants to States to for the purpose of implementing, enhancing, or expanding the provision of assistance through school-based entities under Medicaid or CHIP.

Despite this amazing victory - the work continues. We must continue to urge ED to reduce barriers to accessing Medicaid services in schools through changes to FEPRA and parental consent requirements as well as urge CMS to follow this law  and be more aggressive in promoting free care, removing TPL barriers, and more, but this is a great and unexpected new policy that should be celebrated.