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

Thursday, November 13, 1:45 to 3:15pm, Property: Hyatt Regency Seattle, Floor: 5th Floor, Room: 512 - Willapa

Session Submission Type: Panel

Abstract

Policymakers have long recognized the potential for schools to provide early identification and management of youth health issues. Policies such as the Bipartisan Safer Communities Act (BSCA), the 2014 free care policy reversal, and federal grants have directed more funding to bring more mental health personnel into schools. Medicaid reimbursement for services provided to students is one strategy schools can use to fund and retain mental health professionals, and to that end, the BSCA called for an update by the Centers for Medicare & Medicaid Services (CMS) to the rules that determine what is eligible for reimbursement and how schools can submit for Medicaid reimbursement. Before the 2014 free care policy reversal, schools could not receive Medicaid reimbursement for services unless they were provided via an Individualized Educational Program. Since then, states have the option of expanding Medicaid to take advantage of reimbursement for services provided to any Medicaid-enrolled student. To encourage more states to support reimbursement of school-based health services, the new CMS guide strives to decrease administrative burdens on schools and develop easier methods for requesting reimbursement. Altogether, these are important policy changes to understand and investigate the extent to which they are increasing the presence of health professionals in schools and the receipt of Medicaid-funded school-based health services by children.


The panel includes three papers that address the opportunity Medicaid reimbursement presents for increasing provision of school-based health services and investigate how these recent policy changes are affecting school finances, staffing, billing practices, and children’s receipt of Medicaid-funded school-based health services. The first paper, The Impact of the Medicaid “Free Care” Reversal on School District Finances and Staffing, uses panel data on the universe of U.S. public K-12 school districts from 2010-11-2022-23 and differences-in-differences methods to analyze the impact of the 2014 free care policy reversal on four key outcomes: school district revenue, student support expenditures, student-to-support staff ratios, and student-to-counselor ratios. The second paper, Early school Medicaid expansions and health services for children with parental opioid use disorder, examines the early effects of state school Medicaid expansions following the free care policy reversal on receipt of Medicaid-funded school-based health services among children who have experienced parental opioid use disorder. This study likewise draws on longitudinal, nationwide Medicaid claims data and uses a difference-in-differences design to understand the effects of this policy change on receipt of school-based health services, primary care, prevention, rehabilitative, dental, and mental health services, emergency room visits, and other outcomes. Lastly, the third paper, Intergovernmental Cooperation and Administrative Burdens that Support or Impede School-based Medicaid Adoption, draws on qualitative data collected in interviews with individuals in state Medicaid and education agencies and local education agencies to understand why many school districts do not leverage the opportunity to bill Medicaid for health services provided to children at school. Through the conceptual lenses of administrative burden and intergovernmental cooperation, the authors investigate the administrative burdens associated with school-based Medicaid billing and identify areas for improved intergovernmental cooperation to increase school capacities for Medicaid billing.

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