Ensuring that children and adolescents have the necessary support for their growth and development is crucial for their long-term health and well-being. One effective way to ensure children and adolescents receive preventive health services is by bringing care to where they spend much of their time: schools. School-based services (SBS) include a range of services such as preventive care, screenings, reproductive health, vision and dental care, and support for students with chronic health conditions. SBS can be offered through school-based health centers (SBHCs), which are clinics located on school campuses. They are typically sponsored by local entities, such as hospital systems or pediatric groups, which have additional capacity and resources that allow SBHCs to offer a more comprehensive set of services than a school nurse’s office.
With more than 3,900 centers across 47 states and the District of Columbia, SBHCs can improve access to mental health services, which is critical given the rise of anxiety and depression among youth and adolescents. In addition to health outcomes, SBHCs can improve academic performance and graduation rates by reducing absenteeism due to illness or attending appointments outside of school.
With over 37 million children enrolled in Medicaid, states seeking to improve access to preventive services for this population may consider how Medicaid can support school-based health services. This blog post explores three key considerations for state Medicaid agencies looking to enhance access to care for Medicaid-eligible children through SBS.
1. Expand access to school-based health services through Medicaid levers
States can use a variety of Medicaid levers to expand access to health care services for children and adolescents in school settings. In 2023, the Centers for Medicare & Medicaid Services (CMS) released resources for states looking to improve coordination of school-based health services, including guidance around delivery of services, considerations for parental consent, and information to support billing and claims, since cost allocation and claims processing can be complicated. For states looking to incorporate school-based services into their state plan, CMS offers a readiness tool designed to help Medicaid agencies draft language for state plan amendments. States with managed care programs can add language into their managed care contracts requiring managed care organizations (MCOs) to offer school-based services. In addition, states may partner with MCOs to better understand how to ensure access and availability of these services to Medicaid-eligible students. Both New Mexico and Louisiana include SBHCs as a covered provider within their managed care contracts, ensuring that students have access to SBHC services.
2. Leverage cross-sector partnerships
SBHCs require coordination across various child-serving state and local agencies, including Medicaid, local educational agencies, health systems, and community-based organizations. State Medicaid agencies can use interagency agreements or memorandums of understanding to clearly define roles and responsibilities across agencies, ensuring compliance with federal and state regulations.
While it is important for state agencies to clearly understand their roles in implementing SBHCs, clarity is also important for the health systems and schools. States may consider creating informational materials and offering webinars to help organizations interested in launching or currently operating SBHCs. For example, North Dakota and Maine offer policy guides with key information to support SBHCs. To foster collaboration among various stakeholders, states may consider creating a coalition or task force to address student health needs, regional access, and barriers to success — ultimately informing policies and procedures that support the expansion of SBHC efforts. For example, Maryland established the Council of Advancement of School-Based Health Centers, which includes representatives from SBHCs, the Department of Health, the Maryland Association of Boards of Education, and MCOs. The California School-Based Health Alliance created regional coalitions in areas of highest student health need, identified through their student health index, to bring together local stakeholders to expand access to SBHCs.
3. Support spread and scale through metrics
Collecting and analyzing data from SBHCs is crucial to show improvements in health and educational outcomes for students — and also key to building increased support for SBHCs. Data can reveal how students access available services, the quality of care received, and the cost-effectiveness of improved health outcomes. These insights can help inform future policy decisions that lead to broader adoption of SBHCs. For states with well-established SBHCs, these metrics can be used to foster quality improvement initiatives or continued support for these programs.
One way states may consider gathering more accurate data is by authorizing SBHCs as a specific provider type. This ensures the claims data from SBHCs is easily identifiable as they will be attributed under the provider type. This can make it easier for Medicaid agencies to understand the number of services provided in the SBHC setting, identify the most utilized services, and monitor trends in service use. Illinois allows SBHCs to enroll as a provider if they adhere to the standards and certifications required by the Medicaid program.
Looking Ahead
Offering preventive health services through schools can increase access and improve health and educational outcomes for children. Given the effectiveness of school-based health centers, state Medicaid agencies may consider how their programs can help support the expansion of these centers to increase access to critical health services for the Medicaid-eligible pediatric population. State Medicaid agencies, local educational agencies, health systems, and other child health advocates can consider the above strategies to support Medicaid-eligible students in accessing the health care services they need.
