After the 2018 tragedy in Parkland, Fla., AASA heard from
countless school leaders that Congress needed to “do something” to make it
easier and more affordable for districts to meet the increasing mental
healthcare needs of children. We took this concern seriously and throughout the
past year connected with experts and policymakers in the healthcare and
education fields to try and understand what, if anything, could be done at the
federal level to improve access to and the delivery of healthcare services—particularly
mental healthcare services for children.
Through the culmination of our work, AASA released a report in February examining the school-based Medicaid program and the role it plays in enabling
districts to meet mandates under IDEA as well as provide enhanced healthcare
services to Medicaid eligible children.
Medicaid is actually the third largest funding stream (after
Title and IDEA) provided to districts, yet it represents less than 1 percent of
Medicaid spending annually. Districts began billing Medicaid in earnest in the
early 1990’s for services directly related to a child’s IEP. However, more
districts lately have taken advantage of Medicaid to do screenings, provide
transportation to children, enroll kids in the Medicaid program and coordinate
healthcare services with outside providers.
In 2017, we surveyed school leaders and found they used the
reimbursement stream from Medicaid to hire and keep school personnel who can
deliver healthcare services to kids. Delivering healthcare services to kids in
school, the place they spend most of their time, is the most logical and
efficient way of reducing health barriers to learning early and effectively.
Unfortunately, our aforementioned report found that there
are major barriers to participate in the school-based Medicaid program and that
many small and rural high-poverty districts are totally precluded from pulling
down resources via Medicaid that could be critically helpful to meeting the
educational and healthcare needs of their students.
Why aren’t school districts participating in the Medicaid
program? It has to do with guidance that the Centers for Medicaid and Medicare
(CMS) drafted in 2003 that forced school districts to bill like clinics and
other healthcare providers. CMS was concerned by fraud and abuse in the program
and thought they needed to crack down on school districts. What wound up
happening was total overkill. They created a very duplicative and onerous
billing system for districts that did not recognize that schools are different
from doctors’ offices in many ways and that Medicaid and schools have a unique
financial relationship unlike other healthcare entities.
While some school systems were able to manage the new
billing systems and requirements by hiring folks to handle the paperwork in house,
many districts were forced to contract with third-party billing companies to
manage the paperwork in order to continue participating. Based on our report, the
result of this fairly ancient CMS guidance is that there are now real structural
inequities in the implementation of the school-based Medicaid program that have
permanently shut out smaller, high-need districts from pulling down much needed
federal resources.
Our goal this Congress is to fix these inequitable policies
in the school-based Medicaid program. Thankfully, our policy solution doesn’t
cost much money and doesn’t even require a change to any statute or regulation,
but it does require a bipartisan commitment in the House and Senate to improve
the efficiency of the school-based Medicaid program so more districts and kids
can access Medicaid reimbursable services.
Specifically, we are asking Congress to place a mandate
requiring CMS to issue new guidance that would provide states with the
flexibility to utilize a cost-based reimbursement system that would
dramatically reduce paperwork that providers need to complete and make it far
simpler for districts to bill Medicaid for healthcare services for kids.
This has two major benefits: First, it makes our SISPs,
nurses and other healthcare providers happy because they get to spend more time
helping kids each day and deal with a lot less paperwork on the back end (which
frequently drives them out of working in school-based settings). Second, it
allows districts to recoup costs that are currently being spent on a billing
agency and utilize those resources to expand healthcare services for children or
free up local dollars to support other health or educational initiatives.
What can you do to help? We are hopeful we’ll have bipartisan
legislation in the House and Senate this summer that would streamline the
Medicaid paperwork for districts and incentivize states and districts to expand
healthcare access to kids in schools. When those bills are introduced, please
take a moment to reach out to your Representative and Senators and tell them
you support any legislative proposals that would address the healthcare issues
of your students that get in the way of their academic success.
At a time when we have an uptick in children who lack health
insurance coverage and a surge in children coming to school with unaddressed
mental health needs, there is an urgency to improve the reimbursement stream
for school-based Medicaid programs so schools can deliver more services to more
students. This new reimbursement model for schools has the potential to benefit
students and families, district personnel and administrators and ensure more
efficient and effective delivery of healthcare services to children in schools.