Expanding Medicaid Services in Schools: A Learning Collaborative Convening

Caroline E. Adams and Faith Reynolds

In June, the IMI Staff had the privilege of attending the Healthy Students, Promising Futures Learning Collaborative, hosted by Healthy Schools Campaign and Trust for America’s Health. The purpose of the event was to identify and discuss ways to provide better support for children’s health and wellness in schools. This conference brought together state teams from various State Medicaid departments and State Departments of Education, school district representatives, and other important advocacy groups such as the Colorado Consortium and Communities in Schools. With support from the Healthy Schools Campaign and Trust for America’s Health, this cooperative was designed to aid states that choose to expand Medicaid services in schools and is motivated by the belief that “healthy students are better learners.” The collaborative focuses on the idea that school-based health care services are a great opportunity to provide access to better care for underserved, school-aged children. 

The conference was opened by the United States Surgeon General, Vice Admiral Jerome M. Adams, M.D., M.P.H. In addition to highlighting the importance of his strategic plan as the current Surgeon General, “better health, through better partnerships,” Dr. Adams identified three of his top priorities as acting Surgeon General: opioid addiction, health and the economy, and health and national security. Dr. Adams outlined how each priority intersects with both education and student health. Dr. Adams noted the strong ties between education and economic and security issues as well as potential opportunities for securing funding through additional sources, such as the Department of Defense. To support these funding initiatives, increased awareness of the intersection of economic issues, security issues, and education is critical. Dr. Adams also mentioned the need for oral health care integration, an increase in school nurses, and use of more primary screening tools such as the use of SBIRT (Screen, Brief Intervention, Referral to Treatment) to be used in school-health settings.

The opening panel, What’s Happening in Washington, provided a general briefing of existing policies and the possible impact on health care and coverage for students and their education. Marielle Kress from the American Academy of Pediatrics cited the article “Medicaid Expansion for Adults Had Measurable ‘Welcome Mat’ Effects On Their Children” published in the Health Affairs journal which discusses the “Welcome Mat Effect” of parental health care coverage (Hudson & Moriya, 2017). Kress emphasized the findings from the study which showed that when parents have access to coverage, more children have access to coverage and demonstrate more positive health outcomes. Medicaid work requirement waivers have the potential to reduce parental coverage, which may negatively impact children. These waivers have been approved in four states and are pending approval in multiple others. Therefore, the potential impact on children’s coverage and health may be significant.

Following this discussion, each participating state team provided an update on their efforts to deliver health services in school settings. The state Medicaid medical director for Kentucky, a new entrant to the collaborative, detailed Kentucky’s new initiatives and approaches to data collection and information sharing. Kentucky links Medicaid claims, education data and workforce information to improve care coordination. Kentucky’s team was excited to join the collaborative and share their experience with working to improve child health. Colorado shared its intentions to involve Accountable Care Organizations (ACOs) in schools to provide case management for children. Ohio and D.C. discussed financing the provision of behavioral health services through Medicaid. Ohio plans to move behavioral health services back into managed care, and D.C. is exploring school-based behavioral health integration.

The conference then divided into several roundtable discussions led by state representatives from their Departments of Education and Medicaid. One of the discussions, Strategies for Engaging Medicaid, focused on ways to advance student health and access to care by engaging with state Medicaid agencies. Mark Smith of the Ohio Department of Education highlighted the importance of building a bridge between state Medicaid offices and Education departments by creating a shared reference guide in order to set a standard Medicaid language. He noted that system progress and improvements are more likely when the two offices can understand each other. The other participating representatives at the roundtable agreed and shared stories of barriers in their states and strategies to overcome those barriers. Multiple state teams expressed that reimbursement for provided services was one barrier experienced when proposing new policies for school-based health care. One state Department of Education emphasized that each state team needs to understand their respective state’s managed care models before proposing any policies to overcome this issue.

The second day of the conference focused on Medicaid policy and reimbursement for school-based services. A representative from the Centers for Medicare and Medicaid Services (CMS) described how school-based and other providers can be reimbursed for services covered under the state plan. Opportunities for service provision through telehealth or free care were also presented. Due to the flexibility of telehealth in Medicaid, states have the ability to design programs specific to their needs. Lastly, hospital representatives discussed the use of their community benefit programs to address social and health needs in partnership with schools. These partnerships may bring mobile health clinics, ancillary services or other resources directly to students in need.  For example, one hospital provides glasses to needy children so that kids can have a pair at home and at school.  While another program offered for free vouchers for activities to support wellness, including mindfulness meditation.

Overall, the conference successfully brought together a diverse group of stakeholders all committed to improving child and adolescent health through innovative strategies and partnerships in school settings. While changes in Medicaid or other policy may impact the collaborative’s future efforts, each team left the conference better prepared to address access to quality health care for students in their state. Going forward, it will be important to leverage the connections and resources that each partner brings to the collaborative for continued progress. IMI looks forward to incorporating what we’ve learned through this collaborative into our newly established subcommittee on child and adolescent health – stay tuned!

References

Hudson, J. L., & Moriya, A. S. (2017, 09). Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children. Health Affairs, 36(9), 1643-1651. doi:10.1377/hlthaff.2017.0347