The Advocate July 2022

It’s with great excitement to share the legislation AASA helped write and have introduced was signed into law as part of the bipartisan gun legislation known as the Safer Communities Act. We are thrilled that the policy we have long championed to improve and expand access to mental health services, as well as all healthcare services in schools, will now become a reality.

AASA spent the past decade urging the Centers for Medicare and Medicaid (CMS) to dramatically revisit their guidance on how districts claim and bill for Medicaid-reimbursable healthcare services. Frustrated about the inaction by multiple federal administrations, in 2019 we issued a report urging Congress to force CMS to issue new guidance on the program that would streamline the paperwork requirements for districts. 

In March, President Biden announced his administration would take steps to revise the program and reduce operational barriers to participation. For the last few months, we have been meeting actively with CMS and our conversations with staff led us to believe there was hesitation to make the bold, transformative changes to the school-based Medicaid program that would dramatically streamline the paperwork for districts and reduce the administrative burden on districts. 

After the tragedy in Uvalde, we led a letter to Congress signed by all the major K-12 education groups asking that they address the Medicaid reimbursement issue as a way of tackling the mental health crisis. We are happy to see our specific asks for the revised Medicaid guidance addressed in the law. 

Specifically, the Safer Communities Act requires CMS to move quickly to update the rules governing school-based Medicaid programs to reduce the administrative burdens that are particularly acute for small and rural districts, opening the door for districts to bill for a variety of healthcare related services they perform every day for students and their families. For years, we have known there are numerous obstacles to obtaining appropriate Medicaid reimbursement for the delivery of healthcare services in schools. As a result, many districts that have high numbers of Medicaid-eligible children do not even attempt to participate in the Medicaid program. 

As districts are faced with more children with critical health and mental healthcare needs and increasing demands for school personnel to provide those services, AASA has developed a specific policy solution that will enable more districts—large, small, urban, and rural, high-poverty and low-poverty—to participate in the Medicaid program. 

Now, Congress has mandated that CMS recognize AASA’s policy solution and allow districts to use a simplified, uniform billing process for direct and administrative healthcare services for direct services such as speech-language pathology, counseling, nursing, etc. as well as care-coordination, transportation, Medicaid enrollment, and other administrative services that they may already provide. In addition to this transformational policy shift, Congress also mandated the creation of a new technical assistance center to help districts maximize their Medicaid billing processes and ensure they follow federal requirements. Congress also granted every state $1 million to operationalize the new billing flexibilities that CMS will issue, so states and districts can shift their programs to take advantage of these new operational efficiencies. 

At a time when we have an uptick in children who lack health insurance coverage and a surge in children coming to school with unaddressed mental health needs, there is an urgency to improve the reimbursement stream for school-based Medicaid programs so schools can deliver more services to more students. This new reimbursement model has the potential to benefit students and families, district personnel and administrators, states and other healthcare partners to ensure more efficient delivery of healthcare services to children in schools.