Maximizing School Medicaid for Substance Use Prevention, Early Intervention & Treatment: 10 Actions States Can Take Now

Oct 15, 2026

Policy brief examining how states can strengthen school-based Medicaid programs to expand access to substance use prevention, early intervention, and treatment. It reviews school Medicaid coverage of substance use services, explains the school Medicaid opportunity and the broader continuum approach states need in their Medicaid plans. It outlines practical actions to improve reimbursement, addresses challenges in covering prevention and early intervention, and recommends additional investments to enhance equity and outcomes for students.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Contents

Introduction

State Medicaid Coverage of Substance Use Services

The School Medicaid Opportunity

How States Can Strengthen Medicaid Reimbursement for Substance Use Services

Challenges of Covering Substance Use Prevention and Early Intervention

Additional Investments to Improve Equity in School-Based Medicaid

Acknowledgments

Additional Resources

May 2024 Maximizing School Medicaid for Substance Use Prevention, Early Intervention & Treatment: 10 Actions States Can Take Now Contents ● Introduction ● State Medicaid Coverage of Substance Use Services ● The School Medicaid Opportunity ● How States Can Strengthen Medicaid Reimbursement for Substance Use Services ● Challenges of Covering Substance Use Prevention and Early Intervention ● Additional Investments to Improve Equity in School-Based Medicaid ● Acknowledgments ● Additional Resources Introduction Over the past 20 years, substance use (SU) among adolescents has decreased to the lowest levels in decades. Today, fewer adolescents use substances than those who do.1 However, certain types of substance use, including alcohol and cannabis, continue to be common among adolescents: ● In 2020 , 10% of 8th graders, 20% of 10th gradersand 34% of 12th graders reported drinking alcohol in the prior 30 days. ● The emergence of vaping has led to an increase in nicotine and cannabis use. Although vaping rates plateaued in 2020 , there is still significant concern about the risk of transition to smoking tobacco among adolescents who vape. ● 20% of adolescents reported vaping cannabis at least once, while 1.1% of 8th graders, 4.4% of 10th graders and 6.9% of 12th graders reported daily cannabis use in 2020 , the highest recorded level since 1991. ● Overdose-related deaths rose three-fold from 2019 to 2021 for young people between the ages of 10 and 19 , increasingly driven by synthetic opioids and most often involving other kinds of substances.2 This policy brief covers the Medicaid school-based services program, in which school districts bill Medicaid on behalf of district employees and contract providers. It does not address reimbursement for the delivery of health services provided by community-based providers or in cases where an external provider, such as a hospital, bills Medicaid for services delivered ina school setting. Similarly, it does not address services delivered by school-based health centers (SBHCs), as billing is not done by the school district on their behalf. While there has been a decline in the use of many substances among adolescents, these public health successes have not been shared equally. Significant racial and ethnic disparities exist, with Black and Lantix adolescents, as well as adolescents from lower socioeconomic backgrounds, demonstrating smaller declines in substance use. Additionally, LGBTQ adolescents are more likely than their cisgender heterosexual peers to report recent substance use and problematic use practices. Inequity among adolescents experiencing overdose deaths is also highlighted by recent findings showing that American Indian and Alaska Native adolescents experienced the highest overdose rate, followed by Latinx adolescents.3 The systems serving young people are often not structured to provide optimal support for learning. In some cases, barriers to successful development such as poverty, discrimination and earlier trauma can reinforce inequities and amplify risks for negative outcomes. 1 Winer JM, Yule AM, Hadland SE, Bagley SM. Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Ann Med. 2022. Retrieved from: [https://pubmed.ncbi.nlm.nih.gov/35900132](https://pubmed.ncbi.nlm.nih.gov/35900132) [2](2 Id.)[ Id.](2 Id.) [3](3 Id.)[ Id.](3 Id.) Healthy Students, Promising Futures [healthystudentspromisingfutures.org](healthystudentspromisingfutures.org) 2 Schools provide an opportunity to invest in student health and wellness through a public health approach to prevention and early intervention. Yet 14 million students attend schools that have a law enforcement officer on site but lack a counselor, nurse, psychologist or social worker.4 The vast majority of students (90%) attend public schools with staffing ratios for these positions that do not meet professional standards.5

FAQs

What is the focus of this policy brief?

The brief focuses on the Medicaid school-based services program and how states can increase reimbursement for substance use prevention, early intervention, and treatment provided by school districts.

Why do states need to adjust their Medicaid state plans for substance use services?

Because the school Medicaid program’s success depends on the state plan; an equitable plan should cover the full continuum of services and ensure beneficiaries can access qualified providers.

What equity concerns does the brief highlight?

It points to racial, ethnic, and socioeconomic disparities in declines in substance use, differences affecting LGBTQ adolescents, and inequities in overdose deaths, including higher overdose rates among American Indian and Alaska Native adolescents.

Oct 15, 2026

Upload by Sophia Brooks