As the last few weeks of summer come to an end, families and school districts are preparing for the return of students to the classroom. After a year and a half of living and (largely virtual) schooling during an unprecedented pandemic, the start of this school year can serve as a prime opportunity for school systems and their partners to ensure that children have the services and supports they need to succeed.

As discussed in our previous post, the pandemic has taken an unprecedented toll on the mental health of children. Multiple studies have found that children’s mental health needs increased during the pandemic and that despite an overall rebound in many services, there remains a notable gap in mental health care when compared to pre-pandemic rates. Fortunately, with new COVID relief funding alongside existing Medicaid flexibilities there are real opportunities for schools to step up to address such gaps.

A new report from the Council of Chief State School Officers in collaboration with the National Center for School Mental Health and the Healthy Schools Campaign discusses ways for state education agencies and their partners to employ new COVID relief funding to support student and staff wellbeing and connect students with needed mental health care. As highlighted in the report, Leveraging Federal Covid Relief Funding & Medicaid to Support Student & Staff Wellbeing & Connection, Congress provided $190 billion in emergency funding through various COVID relief bills to K-12 schools under the Elementary and Secondary School Emergency Relief Fund. While this funding is a one-time infusion into the K-12 system, the report provides a helpful overview and examples of how such funding could be leveraged to make strategic investments that provide more sustainable and longer-term support for school-based mental health programs and services under Medicaid.

Examples from the report of opportunities to use the new COVID relief funds to better understand the policy environment, foster collaboration, and strengthen and expand Medicaid school-based programs include: 

• Analyzing policy needs at the state level to promote student mental health and school climate.
• Conducting a scan for state-level legislation and policies that are inclusive of mental health, equity, trauma-informed practices, and positive school climate and culture.
• Engaging families, youth, and communities in planning and implementing school mental health services and programs.
• Prioritizing investment in Medicaid eligible providers such as hiring additional school mental health professionals and contracting with local mental health providers.
• Funding learning cohorts and developing and disseminating materials to implement and expand school-based Medicaid programs.
• Investing in infrastructure projects such as technical support, training and equipment (e.g., to assist with billing or documentation under Medicaid), telehealth technology and training, and grants to local education agencies and school-based community providers to cover startup costs.

If employed strategically, these new funds hold real promise for advancing and expanding access to school-based services including for children with mental health needs. However, in order for states and schools to make the most of this opportunity, they will also need to ensure they are able to bill Medicaid for services delivered to Medicaid-enrolled children, and not just those with a special education plan under an Individualized Education Program (IEP).

As discussed in previous CCF blog posts, under 2014 guidance from the Centers for Medicare & Medicaid Services (CMS), the Medicaid “free care” policy was reversed. Under this policy reversal, states are now allowed to bill for services delivered in schools to students receiving Medicaid without an IEP restriction as long as the services would otherwise be covered under the state plan, are delivered by a qualified provider, and are billed appropriately. In order to ensure states can take full advantage of the flexibility and that schools can bill for such services, some states may need to take additional action such as submitting a state plan amendment (SPA) to CMS. To date, multiple states have received approval of their submitted SPAs.

To find out where your state stands on implementation of the Medicaid free care policy reversal and whether more action may be needed, see here. 

In addition, to learn more about other COVID relief funding opportunities that can support mental health care and services under Medicaid, read our blog post, American Rescue Plan Offers States Funding to Address Critical Need for Improved Access to Mental Health Services.