CMS Approval Expands School-Based Health Services in Illinois

The Centers for Medicare and Medicaid Services (CMS) has approved a state plan amendment (SPA) in Illinois to expand school-based health services for children with Medicaid.

The SPA will allow Illinois schools to receive more Medicaid funding to cover healthcare services for all children who have Medicaid coverage. Previously, schools only received funding for covered services for children with an individualized education program (IEP).

The approval furthers the Biden-Harris Administration’s goal of improving access to youth mental health services by expanding school-based health services. The approval also supports President Biden’s call to address the country’s mental health crisis and its impact on children.

“Today we celebrate the historic action taken by Illinois to expand access to critical health care services in schools for eligible children,” HHS Secretary Xavier Becerra said in the press release. “The Biden-Harris Administration is committed to meeting children where they are to provide care that addresses the challenges our nation’s youth are facing, including mental health challenges. I am hopeful additional states will follow Illinois’ lead.”

Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 41 million children, making schools a convenient setting to deliver healthcare services to kids and adolescents.

School-based health services can include preventive care, physical and occupational therapy, behavioral health services, and disease management. These services have boosted both health and academic outcomes for children enrolled in Medicaid, according to CMS.

“We’re thrilled to partner with states like Illinois to seize opportunities in Medicaid to expand access to health care in schools,” said CMS Administrator Chiquita Brooks-LaSure. “CMS encourages all states to consider adopting this flexibility. It just makes sense to deliver health care services and supports to children where they spend the majority of their time: in school.”

Eleven states have already expanded Medicaid payment for school-based healthcare services under their state plans: Arizona, California, Colorado, Connecticut, Georgia, Kentucky, Louisiana, Massachusetts, Michigan, Nevada, and North Carolina.

The most recent SPA approval in Illinois is just one way CMS and HHS have worked to increase access to school-based health services for children with Medicaid.

In 2022, Secretary Becerra and US Department of Education Secretary Miguel Cardona sent two letters encouraging states to use federal resources, including Medicaid, to expand school-based health services for children. CMS and CHIP have also released guidance outlining best practices for delivering healthcare services to children in schools.

As part of the Biden-Harris Administration’s Bipartisan Safer Communities Act, CMS plans to release a comprehensive guide to Medicaid services and administrative claiming and announce a funding opportunity for $50 million in grants for states to improve school-based health services. In addition, the agency expects to partner with the Department of Education to launch a school-based services technical assistance center.