New resources and proposed regulations from the US Departments of Education, Health and Human Services advance the government's commitment to expanding access to health care and addressing the youth mental health crisis
Today, on Mental Health Awareness Day, the Biden-Harris administration is taking bold action to make it easier for schools to provide essential health services, especially mental health services, to millions of students across the country. These three significant actions support President Biden's comprehensive national mental health strategy and fulfill his commitment to address the country's mental health crisis as part of his unity agenda. Through a series of recent announcements from the US Departments of Education (ED) and Departments of Health and Human Services (HHS), the government continues to take a state-of-the-art approach to meeting families where they are and ensuring children have access to them the health care they need – especially mental health services.
Specifically, ED is proposing a new rule that would simplify Medicaid billing eligibility for students with disabilities. ED estimates that of the 500,000 new students who are deemed eligible under the Individuals with Disabilities Education Act (IDEA) Part B each year, nearly 300,000 are likely to be eligible for Medicaid and affected by this rule. HHS is issuing new guidance to make it easier for schools to bill Medicaid. HHS also approves requests from New Mexico and Oregon to expand the health services schools can provide to Medicaid-enrolled students.
"Students are six times more likely to seek mental health care when these services are available in school, and that's a big reason why facilitating the delivery of health care to schools has been the focus of efforts in the Biden-Harris Administration stands to address the mental health challenges of young people. "We will overcome the health crisis and raise the bar for the learning conditions in our schools," said US Secretary of Education Miguel Cardona. "These new resources and proposed rules will help schools fulfill their promise that all students, including those with disabilities, receive a free, decent public education." We must continue to break down barriers that have long held state and local efforts to improve education undermined the provision of health services to students, including those covered by Medicaid. Ultimately, the actions of the Biden-Harris administration today will give more children and youth access to the physical and mental health services they need to thrive in school and in life.”
"We are taking bold action to strengthen school health care through our Medicaid program so children in every community have the support they need," said HHS Secretary Xavier Becerra. "President Biden has made it clear that strengthening the mental health of young people is a top priority for this administration." We are working across the federal government, state, territory and tribe to meet families where they are and to provide students with the services and support they need to be healthy and thriving.”
IDEA Act Notice of Proposed Regulation
ED is issuing a notice of proposed rules under IDEA that would streamline consent requirements for billing for Medicaid services provided under a student's Individualized Education Program (IEP). This would result in a consistent process that would apply to all children enrolled in Medicaid, regardless of their disability.
Many children with disabilities who receive benefits under IDEA are also enrolled in Medicaid either because of their disability status and/or because of their family income. Children with disabilities are more likely to have low incomes, and those insured through Medicaid are more likely to have greater health care needs than those who are privately insured. Additionally, the COVID-19 pandemic has limited access to essential services for children with disabilities and other vulnerable populations. To achieve the Administration's goal of increasing access to health and mental health services, and in compliance with the Bipartisan Safer Communities Act (BSCA), to expand access to essential school-based services for mental health and other care needs, the removal of critical barriers for schools to more easily provide Medicaid-covered services to their Medicaid-enrolled students.
Importantly, the proposed changes announced today do not change the critical parental consent provisions required by IDEA, nor do they affect parental consent obligations under the Family Educational Records and Privacy Act (FERPA). In addition, the proposed rule does not change the requirement that IEP services be provided free of charge to the child's family, the requirement that IEP services not interfere with other Medicaid-reimbursable services, or Medicaid's position as a payer of first instance for IEP and individualized family service plan services. Rather, this regulatory change would help reduce unnecessary red tape for schools and counties in billing for Medicaid and meeting their obligations to ensure students with disabilities receive a free, appropriate public education consistent with their IEP.
Guide to expanding school-based services for millions of students
Today, through the Centers for Medicare & Medicaid Services (CMS), HHS is releasing a comprehensive guide to school-based Medicaid services to make it easier for schools to provide and pay for health care for millions of eligible students. Developed in consultation with ED, theComprehensive guide to Medicaid services and administrative entitlementsrepresents an important part of the implementation of the BSCA by the Biden-Harris administration.
In addition to providing billions of dollars in funding for school-based mental health workers and helping create safe and welcoming school environments, BSCA engaged ED and HHS to expand access to school-based health and behavioral health services. The guidance released today describes flexibilities that states can introduce to make it easier for schools to get paid for these important health services provided to children enrolled in Medicaid and the Children's Health Insurance Program (CHIP), which work together More than half of all children provide health insurance to children in the United States.
"Through this guide, we're helping states and schools bring health care to children where they are, not the other way around," said CMS Administrator Chiquita Brooks-LaSure. “Children spend most of their waking hours at school. We also know that children's access to mental health and behavioral health services has been severely restricted during the COVID-19 pandemic. We're making it easier for states and schools to maximize Medicaid coverage to build connections with care."
Medicaid and CHIP cover more than half of all children in this country. That's more than 41 million children spending more than 30 hours a week in school for most of the year. This comprehensive policy guide helps states and schools leverage Medicaid and CHIP and provides a roadmap for bridging education and health care, including mental health care, to support and empower children enrolled in these programs help to be successful.
The guide clarifies, consolidates, and expands on a wealth of CMS guidance on how schools can receive payment for the care of Medicaid and CHIP-enrolled students and how states can reduce the administrative burden on school-based healthcare providers to encourage their participation in Medicaid and CHIP and at the same time meet the legal and official requirements of the federal government. This includes helping states and schools implement the following:
- How payments for school-based services may be made under Medicaid and CHIP;
- How states can simplify billing for school services, including in rural and small or underserved communities where childcare can be particularly challenging.
- Examples of approved methods used by government agencies to pay for Covered Services; And
- How to enroll qualified healthcare providers to participate in Medicaid and provide services in the school setting.
In the coming months, CMS plans to allocate additional resources to ensure states can improve children's access to school services. As outlined by BSCA, these resources include $50 million in grant opportunities and a technical support center for school-based services in partnership with ED. For more information on the guide, seeMedicaid.gov.
Permission to expand school-based services in New Mexico and Oregon
HHS, through CMS, also approved State Plan Amendments (SPAs) for New Mexico and Oregon that allow Medicaid to pay for health care services that schools provide to more of their Medicaid-enrolled students. Specifically, these SPAs will allow New Mexico and Oregon to receive Medicaid funding for services provided to all Medicaid-covered children, not just those children with an IEP. These approvals expand access to school-based health services, a key priority for the Biden-Harris administration that will strengthen Medicaid and help provide resources to address the mental health crisis in youth. New Mexico and Oregon join 12 other states that have already expanded Medicaid payment for school-based health services as part of their state plans. These states include: Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Michigan, Nevada, and North Carolina.
Collectively, these announcements are part of the Biden-Harris administration's commitment to address the country's mental health crisis by providing more school-based resources and support to address the mental health needs of students. Today's announcement follows ED's announcement earlier this week of the latest awards tranche to train mental health professionals in schools under the Mental Health Service Professionals Demonstration Program, which provided nearly $100 million more in awards as part of a total granting of an additional nearly $100 million $1 billion to BSCA for mental health services and support in schools.
Overall, these announcements build on actions HHS, CMS and ED have taken over the past year to expand access to school-based health care and trauma-informed services. Last summer, CMS released guidelines for states to strengthen the delivery of behavior-based youth health services and school-based Medicaid and Children Health Insurance Program (CHIP) services. ED announced this last fallGrant for stronger connectionsProgram that awarded a total of $1 billion in grants to 56 states and territories through BSCA to help schools in needy counties provide students with safe, welcoming, and supportive learning opportunities and environments critical to their success . Also HHS last winterAwarded nearly $245 millionExpanding trauma-informed services and support for students and their families, including grants for state and local educational activities to strengthen school-based services.
And at the start of the 2022-2023 school year, Ministers of Education Dr. Miguel Cardona and Health Minister Xavier Becerra oneBriefto governors across the country to highlight the federal funds available to states and schools to invest in student mental health services. ED also provided $122 billion in American Rescue Plan emergency relief funds for elementary and secondary schools to help school reopening and recovery, and experts say more than $2 billion has been spent on hiring more School psychologists, counselors and other mental health professionals in the K-12 range were deployed to schools. With the help of these funds, in March 2023, compared to pre-pandemic levels, the number of school social workers has increased by 48%, the number of school nurses has increased by 42%, and the number of school counselors and school psychologists have each increased by 10%.