As the founder of a public boarding school in Baton Rouge, Louisiana, Sarah Broome saw Medicaid as a logical way to pay for much-needed mental health services for students.
Many Thrive Academy students came from low-income families and had histories of trauma. Broome wanted to bring in social workers and counselors to lead group therapy and individual treatment.
But, while these services were covered by Louisiana’s Medicaid program, cutting through the paperwork to request payment was much more difficult than Broome had anticipated.
“To implement school Medicaid, I had to add running a health care organization to my job,” said Broome, who now works full-time as a school Medicaid consultant. “There are things that are normal in this world that weren’t normal in my world.”
Obstacles such as confusing billing codes and outdated federal guidelines have made the school’s Medicaid billing process so difficult that some administrators aren’t even trying — leaving money on the table that could pay for medical treatments. and mental health that students so badly need, advocates say.
They hope new federal measures will change that, providing crucial resources to schools to help them navigate the bureaucratic maze and opening up a stream of long-term funding to help them deal with a widely recognized youth mental health crisis. .
These measures were included in the bipartisan Safer Communities Acta legislative package passed by Congress after the May 24 school shooting in Uvalde, Texas.
Federal Centers for Medicare & Medicaid Services Required by Law to Update Tech Support Guide for Schools that hasn’t changed since 1997, long before the use of interventions like telehealth, and to provide best practices for navigating complicated billing procedures.
It also provides $50 million in grants to states to implement or expand school-based Medicaid programs, and it directs federal authorities to establish a technical assistance center to help states and schools find ways to pay for services.
Medicaid is an important funding stream for schools that is often overlooked
The bill’s changes, a longtime goal of education policy and children’s advocacy groups, focus on an eight-year-old policy change involving what’s known as the “Rule of free care”. This change was designed to make it easier for schools to bill Medicaid for services not included in Individualized Student Education Programs, or IEPs, plans that detail accommodations and services for students with disabilities.
In a 2014 letter, the Obama administration told states that the so-called “free care rule” does not apply to schools. Under the rule, schools previously could not seek reimbursement from Medicaid for services provided to Medicaid-enrolled students if they provided those same services free of charge to other students.
The Obama-era shift in focus was intended to give schools an opportunity to help meet the needs of vulnerable students, organizations like the Chicago-based Healthy Schools Campaign said at the time.
But states were initially slow to align their Medicaid programs with the new federal policy, which meant schools couldn’t take advantage of it. This would require states to adjust their federally approved plans and, in some cases, change state law.
As of March 2022, 17 states have adjusted their Medicaid programs in line with “free care” guidelines, according to a tracker maintained by the Healthy Schools Campaign.
But even in those states, some school leaders have struggled to tap into Medicaid dollars because it’s too expensive and complicated, said Sasha Pudelski, advocacy director for AASA, the School Superintendents Association. Education administrators aren’t trained in the complicated world of medical billing, and few states have a designated person to help them figure it out.
Medicaid pays about $4 billion in school services annually, AASA estimates. While that makes Medicaid the third or fourth largest stream of federal funding for many schools, it represents less than 1% of the massive federal program’s overall budget.
This contrast has translated into very little political will to address longstanding problems and inefficiencies, Pudelski said.
But concern about student mental health following the disruptions of the COVID-19 pandemic, coupled with declarations of a crisis by people like US Surgeon General Vivek Murthy, has provided a window for action. The Medicaid provisions of the Safer Communities Act will prompt states to update their programs and resources for schools, Pudelski said.
“If we don’t take this opportunity to change this program, it will never happen,” she said.
Even states that have already passed the “free care” change might be able to free up more dollars by making additional changes, said Broome, the former head of the Baton Rouge school.
For example, states could recognize more school-based health and mental health providers as eligible for Medicaid payment. They could clarify which school nursing services are covered by Medicaid, and they could better align the documentation required by their education agencies with the documentation required by their Medicaid programs.
New funds for mental health services
New Medicaid funds could help schools pay for expenses such as hearing screenings, care coordination for students and health services. But advocates see the biggest opportunity in mental health services.
While many necessary health treatments, such as physical therapy, are already covered by student IEPs and billed to Medicaid, mental health services are often needed by students without such plans.
Long before the pandemic, schools raised concerns about rising rates of depression and anxiety among students. But finding the resources to address these concerns was difficult.
A March analysis of federal data by Education Week found that nearly 40% of all school districts nationwide, enrolling a total of 5.4 million students, did not have a school psychologist in the past year. the first full year of the pandemic. Only 8% of districts have achieved the National Association of School Psychologists’ recommended ratio of 1 school psychologist for every 500 students.
Federal data shows a similar shortage of counselors and social workers in schools. And the student support staff that are there are often too busy with things like special education assessments and scheduling to provide direct guidance to students.
“Everyone is in the same boat as me,” Broome said. “Of course I want to provide mental health services [services]but I can’t afford it.
While COVID-19 relief funds provided by the U.S. bailout can be used to hire new staff and programs, that money must be committed by 2024, leaving school leaders with few answers about how. how to sustain new programs once the money runs out.
But Medicaid could be the answer, Broome said.
After completing the program, Thrive Academy was able to hire two social workers, four contract social workers and two full-time nurses.
These new staff provided individual counselling, group therapy and intensive trauma therapy.
In the year before those changes, students were brought to the emergency room 30 times for suicide risk assessments, Broome said. The following year, only one such visit was necessary.
“The headache it took me to figure that out, I don’t want other school leaders to experience,” she said.