As the founder of a public residential high school in Baton Rouge, La., Sarah Broome saw Medicaid as a logical way to pay for much-needed student mental health services.

Many students at Thrive Academy came from low-income families and had a history of trauma. Broome wanted to bring in social workers and counselors to lead group therapy and individual treatment.

But, while those services were covered by Lousiana’s Medicaid program, cutting through the red tape to file for payment was much more difficult than Broome anticipated.

“To implement school-based Medicaid, I had to add running a health-care organization to my job,” said Broome, who now works full-time as a school Medicaid consultant. “There are things that are normal in that world that were not normal in my world.”

Obstacles like confusing billing codes and outdated federal guidance have made the school Medicaid billing process so difficult that some administrators don’t even try—leaving money on the table that could pay for students’ much-needed medical and mental health treatments, advocates say.

They hope new federal measures will change that, providing crucial resources to schools to help them navigate the bureaucratic maze and open up a long-term funding stream to help them tackle a widely recognized youth mental health crisis.

Those measures were included in the Bipartisan Safer Communities Act, a legislative package Congress passed after the May 24 school shooting in Uvalde, Texas.

The act requires the federal Centers for Medicare & Medicaid Services to update a technical assistance guide for schools that hasn’t changed since 1997, long before the use of interventions like telehealth, and to provide best practices for navigating complicated billing procedures.

It also provides $50 million in grants for states to implement or expand school-based Medicaid programs, and it directs federal officials to set up a technical assistance center to help states and schools find ways to pay for services.

New funds for mental health services

New Medicaid funds could help schools pay for things like hearing screenings, coordinating care for students, and health services. But advocates see the biggest opportunity in mental health services.

While many necessary health treatments, like physical therapy, are already covered by students’ IEPs and billed to Medicaid, mental health services are often needed by students without such plans.

Long before the pandemic, schools reported concerns about climbing rates of depression and anxiety among students. But it was hard to find the resources to address those concerns.

March analysis of federal data by Education Week found that nearly 40 percent of all school districts nationally, enrolling a total of 5.4 million students, did not have a school psychologist in the first full year of the pandemic. Just 8 percent of districts met the National Association of School Psychologists’ recommended ratio of 1 school psychologist to 500 students.


By Evie Blad — August 12, 2022

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