May 8, 2019

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May Advocate

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.  


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