Medicaid barriers raise school healthcare equity concerns

Until 2014, Medicaid did not reimburse schools free for services provided to students enrolled in Medicaid
By: | December 14, 2020
School leaders have had trouble billing Medicaid to establish school-based health centers and hire nurses or counselors to provide audio and visual screenings. (GettyImages/Phynart Studio)School leaders have had trouble billing Medicaid to establish school-based health centers and hire nurses or counselors to provide audio and visual screenings. (GettyImages/Phynart Studio)

Equity concerns have emerged as districts in more than half of U.S. states struggle to use Medicaid to provide students with certain free, school-based healthcare, a new study has found.

School leaders have had trouble establishing school-based health centers and hiring nurses or counselors to provide audio and visual screenings despite a 2014 policy shift meant to make it easier to bill Medicaid for these services, according to a report from the nonprofit Child Trends.

Access to these services have become more critical since the onset of the COVID-19 pandemic, said Andra Wilkinson, a Child Trends health equity expert and lead author of the report.

“Unfortunately, too many children have unmet health needs, especially Black and Brown children and children in low-income households,” Wilkinson said. “Schools are critical partners in delivering health care because they see all children and because health is essential for learning.”


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Until 2014, Medicaid did not reimburse schools free for services provided to students enrolled in Medicaid.

Since the Centers for Medicare and Medicaid Services lifted that restriction, nearly a dozen states expanded reimbursement for school-based health services, says the report, “Early Evidence of Medicaid’s Important Role in School-based Health Services.”

Though state Medicaid expenditures on school-based health services grew from 2010 to 2018, Child Trends’ analysis does not show large increases—even in states that allow schools to bill Medicaid for free healthcare services.

“It’s possible that it is too early in the implementation of these new practices for states to see a huge uptick in spending,” said Wilkinson. “What’s clear is that state leaders are motivated to take advantage of this opportunity to improve access to health care, particularly behavioral and mental health services.”

The report recommends states should:

  • Engage leaders from health and education agencies early in the process.
  • Build relationships with community and advocacy organizations to understand their challenges.
  • Allow time for training, buy-in and implementation.
  • Reach out to the Centers for Medicare and Medicaid Services for guidance.

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