Enhancing School-Based Mental Health Services Access Through Medicaid: This initiative recognizes the pressing need to address the mental health challenges faced by young people. By leveraging federal resources and newly available Medicaid flexibilities, it aims to expand the delivery of mental health services in schools. Collaborative models such as the WSCC model demonstrate the potential for partnerships between education, school health, and public health sectors to improve the well-being of children. Despite increased funding, persistent challenges, including provider shortages, need to be addressed. This effort also highlights the importance of congressional action to combat the youth mental health crisis, emphasizing the need for a coordinated approach to ensure a sufficient supply of professionals for school-based services.
Currently, a significant number of young individuals are grappling with substantial mental health issues. School-based behavioral health services, covered by Medicaid, play a pivotal role in addressing the health and well-being of these youth. Federal policymakers have an opportunity to maximize federal resources and capitalize on new Medicaid flexibilities to expand the availability of mental health services in educational institutions. Collaborative models like the Centers for Disease Control and Prevention’s Whole School, Whole Community, Whole Child (WSCC) model illustrate how the education, school health, and public health sectors can collaborate to enhance the health and well-being of children.
School-based health services (SBHS) have shown promising results, particularly for children at higher risk for mental health challenges, and have attracted attention from policymakers and advocates. Providing these services within school settings improves accessibility by mitigating transportation and geographical obstacles and alleviating the burden on caregivers, who no longer need to take time off work. However, schools looking to expand SBHS face substantial challenges in securing adequate funding and in recruiting and retaining behavioral health professionals. A study conducted in 2022 revealed that only 12 percent of public schools strongly believed they could effectively deliver mental health services to all students in need, with provider shortages being the most commonly cited limitation.
In the past year, Congress allocated additional funding to bolster the availability of mental health services, including SBHS. Through the Bipartisan Safer Communities Act (BSCA), Congress allocated extra funds to strengthen schools’ capacity to meet children’s behavioral health needs. The Consolidated Appropriations Act of 2023 also provided much-needed funding to address the nation’s behavioral health challenges, including $111 million for expanding Department of Education programs designed to increase the availability of mental health services in schools, such as expanding training programs for new school counselors, social workers, and psychologists.
As stipulated by the BSCA, the U.S. Department of Health and Human Services Secretary, in collaboration with the Education Secretary, issued a comprehensive guide to support the delivery of SBHS to Medicaid and Children’s Health Insurance Program beneficiaries within school-based environments. They also established a Technical Assistance Center (TAC) to assist schools and school districts in leveraging federal funding for Medicaid-covered behavioral health services. The guide introduces new flexibilities that state Medicaid agencies can adopt to simplify administrative burdens for schools, school districts, and school-based providers, particularly in low-income and rural communities. These include simplified billing and documentation requirements and greater flexibility for states to establish qualifications for school-based providers and offer higher reimbursement rates. States can readily take advantage of these flexibilities by submitting relevant amendments to their Medicaid plans.
The TAC will assist state Medicaid agencies and schools in navigating the complexities of financing school-based Medicaid services and enhance coordination at the federal level for Medicaid-covered mental health services. In the coming months, the TAC will develop additional resources, including more detailed guidance on billing. Stakeholders are encouraged to suggest topics for further guidance at schoolbasedservices@cms.hhs.gov.
Despite the recent injection of funds, additional federal investments are necessary to address the chronic underfunding of the behavioral health system, especially the workforce responsible for delivering behavioral health services in school-based settings. The expiration of the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act on September 30 offers the next opportunity for Congress to bolster the pipeline of behavioral health professionals. The House Energy and Commerce Committee unanimously advanced bipartisan legislation to reauthorize the SUPPORT Act. Meanwhile, the Senate Health, Education, Labor, and Pensions (HELP) Committee is prioritizing bipartisan discussions on primary care and health workforce legislation, rather than reaching an agreement on SUPPORT Act reauthorization. The recently unveiled Bipartisan Primary Care and Health Workforce Act by Chairman Bernie Sanders and Sen. Roger Marshall provides $55 million to establish new school-based health services and $3 billion in capital funding to help community health centers expand dental and mental health services. This proposal received favorable consideration from the HELP committee on September 21.
As lawmakers craft a healthcare package for the fall, they have an opportunity to ensure that there are sufficient professionals available for states to take full advantage of the new Medicaid flexibilities. Any congressional measures aimed at addressing the escalating youth mental health crisis must tackle provider shortages, particularly within schools, in order to meet the anticipated demand in the coming years. Ensuring an adequate supply of providers to support the mental health needs of young individuals is a crucial component of a comprehensive approach to promoting student well-being.
