In Florida and New Jersey, public schools are adding mental health classes to their curriculum. In Oregon and Utah, students can now take mental health days as excused absences from school. In Georgia, a behavioral health counseling program for students is expanding into all high schools this fall. There’s a growing consensus among medical experts and educators alike that schools need to do more to address students’ mental health needs. The federal-state Medicaid program is an important but under-used source of funding for the work.
About one in five children and adolescents experience a mental, emotional or behavioral disorder each year, but less than one-third of those affected actually receive treatment. When West Virginia advocates surveyed teachers and community providers about children’s health care needs in school, mental health care emerged as the No. 1 unmet need. While gun violence in schools is still relatively rare, 2018 was the worst year on record for school shootings.
The nation’s opioid crisis and its impact on children, adolescents, and families also speak to the urgent need to address mental health concerns and substance use issues in schools. Among adolescents, it is estimated that up to 10 percent experience a substance use disorder. Children separated from their parents because of drug use can suffer from trauma, affecting their behavior at school.
Since children and adolescents spend so much time in school, investing in evidence-based, comprehensive school-based mental health services and substance use prevention and treatment makes sense. So does promoting safe and supportive school environments that address the trauma that some students face.
Recognizing the growing need, the U.S. Centers for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a Joint Informational Bulletin that offers a roadmap to states and schools on the ways Medicaid can support behavioral health services for children and adolescents in schools. The bulletin serves as a permission slip for school districts and states to use Medicaid in ways that promote student mental health.
The bulletin explains that states can amend their state Medicaid plan to cover mental health and substance use services provided in school-based settings. This ensures matching federal funds. Missouri has already begun allowing schools and providers delivering services in schools to bill for services for all students receiving Medicaid. In Georgia, 83 percent of the funding for the APEX behavioral health program comes from Medicaid sources.
Schools can also support an array of behavioral health screenings and counseling under what’s known in Medicaid parlance as the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. States can amend their plans to cover peer-based support services for children and students with mental health challenges or substance use disorders, according to the bulletin.
Medicaid comes into play in certain types of school-based health centers, particularly those that are Federally Qualified Health Centers or Rural Health Clinics. These centers can provide mental health and substance use disorder treatment services to Medicaid-enrolled students at or near a school. The CMS bulletin explains that reimbursement provided can go directly to providers or through a designated managed care organization.
[Read More: How Education and Health Sectors Can Collaborate]
The role of these school-based health centers will only expand with the federal government’s recent decision to broaden the types of health services that schools can bill to Medicaid. Until 2014, schools could only bill for services provided to students with disabilities who had individualized education plans under federal law.
CMS guidance now allows schools to seek payment from Medicaid for health services, including mental health and substance use related services, delivered to all students receiving Medicaid. Some states, such as Louisiana and South Carolina, have begun taking advantage of this change, while others are in the process of changing their state Medicaid plans to broaden school-based billing or change the type of providers who can bill for it. Louisiana officials estimate that school-based Medicaid revenue has tripled in the three years since the state began allowing school nurses to bill Medicaid for their work with eligible students.
Seeking Medicaid reimbursement is notoriously complicated and can scare off some schools and districts. But the need to support students with mental health or substance use issues makes it imperative that they try. The new federal bulletin makes clear what is possible.
Candace Webb is a Senior State Health Policy Analyst at the Georgetown University Center for Children and Families (CCF). A version of this blog post was initially published on the CCF website.