Schools Are Key to Improving Children’s Health - How States Can Leverage Medicaid Funds to Expand School-Based Health Services - January 2020

Oct 15, 2026

Uploaded by Damian

Explains how states can use clarified Medicaid reimbursement rules to expand school-based health services and reach more Medicaid-enrolled students. Highlights evidence that school health access improves health and academic outcomes, especially for children with chronic conditions, while addressing health inequities affecting underserved communities. Describes the 2014 CMS policy clarification, early adoption barriers, and the resulting momentum as multiple states expand programs, including mental health services. Concludes with recommendations for federal and state policymakers to support implementation.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Introduction

The case for school-based Medicaid expansion

Expansion of school-based Medicaid programs as of January 2020

Recommendations for policymakers

SCHOOLS ARE KEY TO IMPROVING CHILDREN’S HEALTH How States Can Leverage Medicaid Funds to Expand School-Based Health Services January 2020 This brief was produced with generous support from Kaiser Permanente, Maico Diagnostics, the Robert Wood Johnson Foundation, School Health Corporation and the William and Flora Hewlett Foundation. The views expressed here were developed independently and do not necessarily reflect the views of these funders. The Healthy Students, Promising Futures Learning Collaborative informed the development of this brief. Trust for America’s Health and Healthy Schools Campaign co-convene the Learning Collaborative with the goal of creating healthier students by increasing Medicaid services in schools and promoting safe and supportive school environments. Sixteen cross-sector state teams currently participate in the Learning Collaborative; members include representatives from state education agencies, state Medicaid agencies, school districts, public health agencies, and state and local advocates. Authors Alex Mays, Healthy Schools Campaign Lena O’Rourke, on behalf of Healthy Schools Campaign Editors Christine Cupaiuolo, on behalf of Healthy Schools Campaign Designer Anne Moertel, on behalf of Healthy Schools Campaign Healthy Schools Campaign Healthy Schools Campaign (HSC) works to ensure that all students have access to healthy school environments, including nutritious food, physical activity and essential health services, so they can learn and thrive. This report was prepared by Healthy Schools Campaign, which is solely responsible for the views expressed. This work is licensed under a Creative Commons Attribution 4.0 International License. INTRODUCTION Research shows that access to school health services improves health and academic outcomes, particularly for students with chronic health issues. But finding sustainable funding has been an ongoing struggle. Healthy Schools Campaign is excited to release this policy brief on the opportunities to expand access to—and resources for—school health services using available Medicaid funds. In December 2014, the Centers for Medicare & Medicaid (CMS) clarified the way that Medicaid would reimburse for health services delivered in schools. School districts, once restricted to reimbursement for services delivered to students enrolled in Medicaid under very specific conditions, were now permitted to cover all eligible services delivered to all Medicaid-enrolled students. Put simply, this meant more healthcare funding for the most disadvantaged students. Even though the federal policy shift also opened the door to greater financial support for states and school districts, most states did not immediately take advantage of it. Many states had codified the original CMS policy, stating that districts could only seek reimbursement for health services delivered under a student’s Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP). Several had formalized the original policy in state law. It took time for early adopter states to develop implementation roadmaps for other states to follow. Now, five years later, significant momentum is building. Ten states—Connecticut, Kentucky, Louisiana, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, North Carolina and South Carolina—have successfully expanded their school-based Medicaid programs (four of them in 2019 alone), with more states working to do so. There is an especially strong interest in leveraging the opportunity to support mental health services. This brief provides an overview of the CMS clarification and details the progress states have made to align state policy with school-based Medicaid. It also offers recommendations for federal and state policymakers to make it easier for more states to follow suit. (For more information on the opportunities to advance state policy, visit HSC’s website.) The CMS clarification allows school districts

FAQs

What change did CMS make regarding Medicaid reimbursement for school health services?

In 2014, CMS clarified how Medicaid reimburses health services delivered in schools, allowing districts to cover all eligible services for Medicaid-enrolled students rather than only those delivered under specific plans.

Why is school-based health services expansion important for children?

Access to school health services improves health and academic outcomes, helping students with chronic issues with attendance, learning ability, and broader academic performance while addressing inequities.

What is the main challenge after CMS clarification?

CMS created an opportunity rather than a mandate, so states need support to implement the policy and allow districts to seek reimbursement for additional school health services.

Oct 15, 2026

Uploaded by Damian