Medicaid Expansion of Mental Health Services in Schools: Initial Qualitative Findings

• In Event: Transformative School-Based Mental Health: Coordinating Services, Accessing Sustainable Funds, and Centering Youth Voice

Abstract

Objectives/Purpose
This qualitative study focuses on understanding Year 1 implementation of school Medicaid expansion in the case example of Chicago Public Schools from the perspective of district administrators and school-based mental health clinicians. School Medicaid expansion (SME) is defined as the ability of schools to receive Medicaid reimbursement for a wider range of school-based mental health services beyond Individualized Education Plan disability-related services. Although the option to expand has been in place since 2014, Illinois recently expanded reimbursement for a wider range of school-based mental health services in 2023. This new reimbursement funding can support schools to expand their provision of mental health services. Previous studies demonstrate that expanding access to health services in schools improves education and health outcomes over the life course (Golberstein et al., 2022; Basch, 2011).

This study examines the experiences of district administrators and school-based clinicians as implementers of Medicaid expansion of student mental health services. This study focuses on understanding how administrators and clinicians 1) perceive the implications of Medicaid funding expansion on improving the provision of and student access to school-based mental health services and 2) experience the process of implementing school Medicaid expansion. This study provides strategies for school districts to implement SME, making a crucial contribution to advancing sustainable mental health funding in schools.

Method, Conceptual Framework, and Data
This study includes 24 semi-structured interviews with purposively selected district administrators and school-based clinicians in Spring 2024. Qualitative interviews were designed using the Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., 2022). CFIR was employed to capture the multi-level implementation process, which includes the perspectives of SME implementers at the district and school level. Thematic analysis was employed to analyze these interviews and followed the five-phase thematic analysis process (Nowell et al., 2017; Braun & Clark, 2006). Interviews were deductively coded using the CFIR and inductively coded with codes developed from the interview transcripts. Themes were developed from the codebook and finalized through research team consensus.

Findings
Findings from this study build the evidence base for SME implementation successes and challenges. Findings across the interviews with clinicians and administrators include the emphasis on administrative burden to implementing SME, low initial identification with the school Medicaid program, commitment to meet mental health needs of students during a time of unprecedented need, and enthusiasm for SME to provide sustainable funding to meet student mental health needs.

Significance
This is an important study in the context of the child mental health crisis and the recent state and federal funding to support districts in expanding school Medicaid funding and building their mental health infrastructure (Panchal et al., 2022). Medicaid is a sustainable funding source for schools and presents a rare opportunity for schools to expand and sustain their mental health services during a time of unprecedented need (Akkas & Corr, 2024; Centers for Disease Control and Prevention, 2023) Additionally, this study sheds light on the non-alignment between education and health training, licensure, and documentation requirements, areas that are critical to address for successful SME implementation.

Author

• Caroline Kelly, University of Chicago