Scaling up school-based health services

All of us at Health Forward recognize that children who are well are more likely to succeed in school and life. That’s why we are proud to have provided nearly $7 million in grants for school-based health services, particularly mental health services (see here, here and here for examples).

Read how school-based therapy is helping kids in the Belton School District.

Health services offered through schools not only fill a health need, but appointments offered on-site reduce school absences, increase appointment retention, and alleviate parental concern regarding time off of work and transportation to appointments.

For children without convenient access to health services, particularly those in rural areas, school-based services offer access that wouldn’t otherwise be available.

While we are proud of our grantmaking to date, we can’t solely sustain these services in perpetuity. We estimate that, if our funding were used to draw down Federal Medical Assistance Percentage (FMAP), we would have leveraged nearly $11 million for these services over the past 10 years.

Oftentimes, school-based services are not reimbursed by Medicaid. In Missouri, it’s entirely possible to have a Medicaid-eligible child receiving a Medicaid-eligible service from a Medicaid-eligible provider, but still be denied reimbursement. Why? Because it took place in a school setting. Put this same scenario in leased space right next door to the school and it would be reimbursed by Medicaid.

Why is this happening?

In an effort to understand the policies surrounding Medicaid reimbursement for school-based services, Health Forward worked with the School-Based Health Alliance to conduct phone interviews with numerous Health Forward grantees (school district and building-level administrators, community-based medical, behavioral and oral health organizations); state agency leaders representing public health and Medicaid; and state-level associations representing school boards, charter schools, community health centers, and state health plans.

The goal of this research was to understand both the programmatic and policy barriers facing school-based health services. We are thrilled to be able to release our Sustaining School-Based Health Services in Missouri report.

Here are some key findings from our research:

  • Missouri Medicaid policy restricts reimbursement for a prescribed set of services provided to students with an Individual Education Plan or IEP.
  • Entities providing Medicaid-covered services on school site to non-IEP Medicaid enrolled students can bill Medicaid using the place of service code of their entity, but use of the school locator code results in denied claims by Medicaid.
  • The use of IEPs, as provided in the federal IDEA law, is not being fully realized. Many students served by grantees have disabilities related to mental health or substance abuse diagnoses requiring extensive mental health or school nursing interventions that would help keep them at school and function adequately to learn. Yet, none of the schools reported that they included in their IEPs emotional or behavioral health issues affecting learning.
  • The Every Student Succeeds Act (ESSA) encourages local education agencies to partner with public or private entities in the community to develop, implement, and evaluate programs to address issues such as substance abuse, mental health, bullying, violence, healthy relationships, nutrition, and physical activity. There is potential for ESSA to support school-based behavioral health for Missouri’s low-income students.

In addition to releasing our report, Health Forward has identified three key strategies for advancing access to school-based health services:

  1. One of Health Forward’s 2018/2019 policy goals is ensuring adequate reimbursement for school-based health services, including:
    • Amending the state’s Medicaid plan to allow reimbursement for all school-based services outside of an IEP, provided they are a Medicaid-eligible service, provider, and child.
    • Allowing community mental health centers, hospitals, federally qualified health centers and other providers to use schools as a valid location code for Medicaid claims when they provide services on school property.
    • Providing state funding for school-based health clinic planning, startup, and ongoing clinical operations.
  2. Over the coming year, Health Forward will partner with our area schools and health providers to facilitate training on school health financing policies and systems.
  3. Lastly, we are exploring opportunities to collaborate with others throughout the state who are interested in supporting and scaling up school-based health services.

School-based health services are a win for all of us — parents, teachers, the community, and especially the children who need these services but may never receive the help they deserve. We are committed to achieving reimbursement for these services so that more schools that already recognize their importance will feel empowered to begin their own on-site programs. Our children deserve the best from us.

3 thoughts on “Scaling up school-based health services

    Love this article. I have an idea that I would love to discuss with someone. Have you thought or are any school based health centers only privately funded? I think it could be done. I have details if anyone can contact me.

    Thank you.
    Kathy Smith

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