The announcement specifically affects the tens of millions of children who receive health care through Medicaid, but all school-age children will benefit from the change because the new guidance makes it clear that schools can use Medicaid dollars to hire school counselors. , nurses and additional social workers. workers who could treat all students. More than half of children in public schools get health care through the Medicaid and CHIP programs.
While the guidance applies to physical and mental health, the Biden administration emphasizes how much this could help children’s mental health.
“We really do have a mental health crisis in our country, particularly with our nation’s children. So the guidance that we’re putting out today is really about encouraging states to try to expand access to mental health services for children,” Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure (CMS) told CNN. “And as part of that, we remind states of their obligations to cover mental health services. And we encourage them to work with schools to ensure children have access to those services.”
The guidance also clarifies a policy change first issued under the Obama administration in 2014 that told schools that Medicaid would pay for any type of health care for any child enrolled in the program. Before that policy change, schools could only bill Medicaid for children enrolled in special education programs. To expand medical services to all children covered by Medicaid, some states had to apply to the federal government, but only 16 states did.
Guidance issued Thursday should encourage remaining states to expand this type of access to school-based health care and also expand mental health services to children in general.
“It’s really giving that assurance that yes, from our perspective, schools should and can get funding through the Medicaid program to provide mental health and other services to children,” Brooks-LaSure said.
This new approach means schools are guaranteed payment for on-site staff who will provide medical and mental health services. It means more children should have better access to preventive care, such as psychological evaluations, immunizations, counseling and screening services that can ensure a child can see and hear. The money could also be used to help a child manage her medication or better care for her asthma.
Before this new guidance, experts say some schools may have been reluctant to provide these services because they worried that Medicaid would not reimburse them and they would have to pay back the money from the school budget. An expense that few schools could afford.
“I think this addresses a number of questions, concerns and issues that will go a long way toward giving states and school districts the confidence to move forward,” said Rochelle Davis, president and CEO of the Health Schools Campaign, a national nonprofit. organization that works with schools to ensure that all children have access to healthy school environments.
Right now, students may have access to some health care at schools, Davis said, but it’s often paid for by the district or philanthropy.
“It’s not sustainable and it doesn’t allow for the comprehensive and coordinated care that is needed,” Davis said. “This allows schools to have the staff in the school and build a sustainable and comprehensive program.”
“Expanded Medicaid funding for school health services is good for students. It’s good for the school and it’s good for public health,” Davis added.
The guidance issued today also makes it clear to states that they cannot place restrictions on mental health services offered to children. For example, states can no longer deny mental health services to children on Medicaid who do not yet have an official mental health diagnosis. Currently, if a child doesn’t have a specific diagnosis, experts say it can be difficult for children to access mental health care like therapy or prescription medications.
“If I’m working with a young child, it can take a while to decide what the diagnosis is. I want to be able to support that child and I don’t want to have to wait until something comes up, but there has been an administrative problem.” barrier there,” said Dr. Marian F. Earls, a pediatrician who serves as chair of the American Association of Pediatrics’ council on Healthy Mental and Emotional Development. “This is a wonderful first step.”
Earls has seen what removing those administrative barriers can do in his own state of North Carolina. She worked closely with the state Medicaid director to remove the same administrative barrier and improved children’s access to care almost immediately.
“It was huge. It was huge,” Earls said. “And it really led to the ability for (pediatric) practices in my state to start integrating a mental health professional into their practice.” Having a mental health professional on staff allowed the practice to care for a child’s physical and mental health.
“It really makes early identification and support easier,” Earls said. Proactively addressing mental health issues can keep kids out of the ER with a crisis.
Davis believes the Biden administration’s announcement today could make a big difference in improving the physical and mental health of this generation of students.
“I think it will be transformative,” he added. “And the bottom line, this is good for students. It’s good for schools and it’s good for the public because you’re using federal resources very efficiently.”
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