Intergovernmental Cooperation and Administrative Burdens that Support or Impede School-based Medicaid Adoption

• In Event: Investigation of Policies for Increasing Children’s Receipt of Medicaid-funded School-based Health Services

Abstract

Public schools have been increasingly proactive in developing interventions to support children’s health, and for some low-income children, they serve as a primary source of health care. Yet despite substantial progress in addressing students’ emergent health needs, school districts face ongoing challenges to finance and sustain their health initiatives.

Medicaid is an important potential source of funding for school-based health services, and some school districts work closely with their state education and Medicaid agencies to support health care services delivered in school settings. But many school districts do not leverage the opportunity to bill Medicaid for services provided. Notably, schools are not typical health care providers, and school-based Medicaid billing arrangements vary by state, depending on State Medicaid agency structures for billing and local school system capacities for billing for services provided.

While school-based Medicaid represents an important opportunity for intergovernmental cooperation in care coordination and public support of children’s health, there are administrative burdens and barriers to developing formal arrangements for health services billing and navigating contracts with state agencies and managed care organizations. Through the conceptual lenses of administrative burden and intergovernmental cooperation, we investigate the administrative burdens associated with school-based Medicaid billing and identify areas for improved intergovernmental cooperation to increase school capacities for Medicaid billing. We draw on interviews conducted with individuals in state Medicaid and/or education agencies (about 30) and local education agencies (approximately 80 school districts) in exploring both opportunities and challenges for expanding school-based Medicaid in the U.S.  We also construct in-depth case-comparisons of states that: 1) have or have not adopted school-based Medicaid, 2) are or are not a Medicaid expansion state, and 3) are receiving federal funding to advance school-based Medicaid.

This research will illuminate policy and administrative pathways to streamlining the process of state and local educational agency adoption of school-based Medicaid and increasing the sustainability and effectiveness of school-based health services for children.

Authors

• Caroline Kelly, The University of Chicago
  Presenting Author

• Carolyn J. Heinrich, Vanderbilt University
  Non-Presenting Co-Author