Mental Health and School-Based Medicaid



Mental health is a big concern among school districts with the need to provide support consistently increasing year over year. At CompuClaim, we are often asked what correlation this has for your School-Based Medicaid Program. Let’s take some time to look at the facts around the impact of increased mental health and behavioral intervention needs that districts are facing across the county. Specifically, around legislation, the Safer Communities Act and what that means for your students.

Special Education Legislative Summit Learnings

CompuClaim recently joined CASE (Council for Advancement and Support of Special Education) and CEC (Council of Exceptional Children) at SELS (Special Education Legislative Summit) where we worked with school districts across the country to lobby our Congress people for the expansion of mental health programs and resources across the country. The workshops and conversations unearthed a plethora of research and discussion about the state of mental health in our youth.

“Approximately 20% of children are experiencing significant mental, emotional, or behavioral symptoms that would qualify them for a psychiatric diagnosis, but only 12% receive services to address these issues. That means nearly 70% of youth with mental health problems do not receive the treatment they need” (Special Education Legislative Summit 2022).

Unfortunately, the COVID-19 pandemic just exacerbated these numbers even more. Looking at youth mental health statistics in the COVID-19 pandemic after lockdown shows a dire need for expanded mental health services:

20% increase of kids experienced depression or anxiety
National screenings show that children, adolescents, and teens have struggled emotionally during the pandemic more than any other age group, with one-third of teen girls and one-fifth of teen boys experiencing a new or worsening anxiety.

Disproportionate impact on underrepresented groups
77% of Black and Latino students reported more struggles with their mental or behavioral health, approximately 9 points higher than their white or Asian counterparts. Low-income students were also substantially more likely to report experiencing such concerns. Additional data show the greater risk of violence, harassment, and discrimination Asian-American students face, and how LGBTQ+ students have experienced increased anxiety and stress.

(JAMA Pediatrics, 2020; Leebet al., 2020; Merikengas, 2014; Moore et al., 2021; Pan et al., 2020)

Children with untreated mental health problems are placed at greater risk for a variety of negative outcomes including…

  • School avoidance
  • Poor school adjustment
  • Learning difficulties
  • Social rejection
  • Aggressive behavior
  • School dropout

While Lobbying with SELS, we joined hundreds of school districts nationwide and urged Congress to:

  • Provide funding for Safe Schools National Activities; ESSA, Title II-A; ESSA, Title IV-A; and IDEA, Part D, Personnel Preparation.
  • Maintain Medicaid to reimburse IDEA services, and support legislation increasing access to MH services through private health insurance and Medicaid.
  • Support policies and funding for services and community interventions for children and youth experiencing trauma, environmental stress & MH symptoms & disorders.
  • Support polices and funding that promote prevention and interdisciplinary partnerships among education and other agencies and providers to ensure children’s social/emotional well-being.

The Safer Communities Act and what that means for Mental Health and School-Based Medicaid

If you get updates from the National Alliance of Medicaid in Education (which we recommend you do!). You will have seen their update on the bipartisan passing of the Safer Communities Act. This bill covered a lot of ground and was created and passed to prevent gun violence and expand mental health resources in schools.

As NAME states in their update, the bill provides direct grants to states to start the hard but meaningful work of changing how they process Medicaid claims. In addition, by allowing for additional ways to expand Medicaid-reimbursable services to schools dramatically, and generally take advantage of the new flexibilities they will be granted via updated guidance to expand healthcare, mainly mental health services, to millions more children” (NAME 2022).

Specifically, the Safer Communities Act:

  • Directs CMS to update guidance on how schools can fully use Medicaid to support mental health programs.
  • Provides millions of dollars in new funding for school-based mental health services.
  • Provides $1 billion to Department of Education grant programs that will grow the workforce of qualified school-based mental health professionals.
  • Provides $1 billion for the Department of Education’s Student Support and Academic Enrichment (Title IV-A) program.

With this act being signed into law it means:

  • Expanded reimbursable services for your Medicaid programs
  • Additional funding to increase Mental Health resources in your district, including psychologists.

Expanding School Medicaid Programs

Recently, the Education Department and U.S. Department of Health and Human Services stated the Centers for Medicare & Medicaid Services is planning to issue an updated free care policy so more schools can receive Medicaid funding for healthcare services — including mental health treatment —schools provide to children enrolled in Medicaid, including mental health treatment. Here at CompuClaim, we believe it is a positive step toward a more sustainable funding approach (not just one-time grants) to ensure students have access to the mental health services they need.

Currently, 16 states—Arkansas, Arizona, California, Colorado, Connecticut, Florida, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, North Carolina, New Hampshire, Nevada, and South Carolina—have expanded their programs to allow qualified school providers to bill for covered behavioral health services for Medicaid-enrolled students beyond those with IEPs.

Connecticut’s expansion includes students with 504 plans, provided for General education students receiving reimbursable Medicaid eligible services. Georgia has also expanded its school Medicaid program but currently has limited additional reimbursement for nursing services.

Another five states—Illinois, Indiana, New Mexico, Oregon, and Virginia—are awaiting final approval of their submitted SPAs in anticipation of expanding their programs and in many cases will be implementing their programs retroactively based on their state directive.

By expanding Mental Health resources, school districts will be able to better help counteract the negative impacts but increasing staff, provide further outreach, train district employees in behavioral interventions, counseling and crisis management just to name a few. We are thankful for the opportunity to advocate for these needs, as the success of our students facing mental health issues is possible if we continue to work together. If you are interested in learning more about advocacy, CASE and NAME are great starts. Contact us if you would like to speak to a specialist about what this means in your state.

About CompuClaim  

CompuClaim values being a part of that collaborative partnership to maximize Medicaid reimbursements and minimize administrative stress. CompuClaim provides a state liaison that will walk you step-by-step through the Medicaid documentation and billing process based on your state’s regulations and individual needs of your district.  

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