Biden Admin Increases Access to School-Based Mental Health Services

The Biden-Harris Administration has announced three initiatives to increase access to school-based mental health services for children with Medicaid.

“We are taking bold actions to strengthen school-based health care services through our Medicaid program so that children in every community have the support they need,” HHS Secretary Xavier Becerra said in the press release.

“President Biden has made clear that strengthening youth mental health is a top priority of this Administration. We are working across the federal government, as well as with all states, territories, and tribes, to meet families where they are and provide students with the services and supports they need to be healthy and thrive.”

The following actions reflect the Administration’s commitment to fulfilling provisions of the Bipartisan Safer Communities Act (BSCA) that prioritize expanding access to school-based behavioral and mental healthcare services.

The US Department of Education (ED) has proposed a new rule to streamline billing permissions for Medicaid services provided through a student’s individualized education program (IEP). The provision would create a uniform process for all children enrolled in Medicaid, regardless of disability.

Many children receiving services under the Individuals with Disabilities Education Act (IDEA) are also enrolled in Medicaid due to their disability status or family income. These children tend to have more healthcare needs than those covered by private insurance.

The proposed rule aims to minimize barriers that schools and districts face when billing Medicaid and ensure students with disabilities have access to a free public education consistent with their IEP, HHS said.

The proposal would not impact the parental consent provisions required by IDEA or the parental consent obligations under the Family Educational Records and Privacy Act (FERPA). The rule would not change the requirement that IEP services be delivered at no cost, nor will it affect Medicaid’s position as the payer of first resort for IEP and Individualized Family Service Plan services.

HHS, through CMS, has also released a comprehensive guide for delivering Medicaid school-based services developed with ED. The guide includes flexibilities states can adopt to make it easier for schools to get paid for providing Medicaid and CHIP beneficiaries with school-based mental health services.

“With this guide, we are helping states and schools bring healthcare to kids where they are, rather than the other way around,” said CMS Administrator Chiquita Brooks-LaSure. “Children spend most of their waking hours in school. We also know that children have suffered serious declines in access to mental and behavioral healthcare services during the COVID-19 pandemic. We’re making it easier for states and schools to maximize Medicaid coverage to grow connections to care.” 

The guide expands on current CMS guidance and shares how states can ease the administrative burden on school-based health providers. The guidance details how payments can be made for school-based services under Medicaid and CHIP, how states can simplify billing, and how to enroll qualified healthcare providers to provide Medicaid-covered services within school settings.

As directed by the BSCA, CMS plans to announce $50 million in grant opportunities and a school-based services technical assistance center to improve access to mental healthcare for children.

The third initiative from HHS includes two approved state plan amendments (SPAs) for New Mexico and Oregon. These approvals will allow the states to receive Medicaid funding for services provided to all children covered by Medicaid instead of only children with an IEP.

Twelve states have already expanded Medicaid payment for school-based healthcare services under their state plans.

These announcements will help address the nation’s youth mental health crisis, as students are six times more likely to access mental healthcare services when they are offered in school, according to US Secretary of Education Miguel Cardona.

“We need to continue breaking down barriers that have long undermined state and local efforts to provide healthcare services to students, including those covered by Medicaid,” Cardona said. “Ultimately, more children and youth will gain access to the physical and mental health services they need to succeed in school and in life as a result of the actions the Biden-Harris Administration is taking today.”