May 30, 2024


The Biden administration announced new plans Thursday that should make it a lot easier for millions of kids to get access to mental and physical health services at school.

The announcement specifically impacts the tens of millions of children who get their health care through Medicaid, but all school age children will benefit from the change because the new guidance makes it clear that schools can use Medicaid dollars to hire additional school counselors, nurses and social workers who could treat all students. More than half of kids in public school get their health care through Medicaid and CHIP programs.

While the guidance applies to physical and mental health, the Biden administration is emphasizing how much this could help children’s mental health.

“We really have a mental health crisis in our country, particularly with our nation’s children. And so the guidance that we are releasing today is really around encouraging states to try to expand access to mental health services for kids,” Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure told CNN. “And as part of that we are reminding states of their obligations to cover mental health services. And we are encouraging states to work with schools to make sure that children get access to those services.”

Prior to the pandemic, the US Centers for Disease Control and Prevention found that 1 in 5 children had a mental health disorder, but only about 20% of those children received care from a mental health provider.

In 2021, more than 44% of high school students said they felt persistent feelings of sadness or hopelessness, according to the CDC.

That same year the American Academy of Pediatrics along with several other associations declared the state of child and adolescent mental health a national emergency.

The guidance also clarifies a policy change first issued under the Obama administration in 2014 that told schools that Medicaid would pay for any type of health care for any child enrolled in the program. Prior to that policy change, schools could only bill Medicaid for children enrolled in special education programs. To expand medical services to all children covered by Medicaid, some states had to apply to the federal government, but only 16 states did.

The guidance issued Thursday should encourage the remaining states to expand this kind of health care access at school and also expand mental health services to children in general.

“It’s really giving that assurance that yes, from our perspective, schools should be and can get funding through the Medicaid program to deliver mental health services as well as other services to kids,” Brooks-LaSure said.

This new approach means that schools are guaranteed payment for staff on site that will provide medical and mental health services. It means that more children should have better access to preventative care like psychological assessments, vaccines, counseling, and screening services that can make sure the child can see and hear. The money could also be used to help a child manage their medicine or take better care of their asthma.

Prior to this new guidance, experts say some schools may have been reluctant to provide these services because they were concerned that they would not get reimbursed by Medicaid and would have to pay the money back out of the school budget. An expense few schools could afford.

“I think this addresses a number of questions and concerns and issues that will go a long way to give states and school districts the confidence to move forward,” said Rochelle Davis, the president and CEO of the Health Schools Campaign, a national nonprofit that works with schools to ensure all kids have access to healthy school environments.

Right now students may have access to some health care at schools, Davis said, but it’s often paid for by the district or by philanthropy.

“It’s not sustainable and it doesn’t allow for the comprehensive and coordinated care that is needed,” Davis said. “This allows schools to have the personnel in school and build up a sustainable and comprehensive program.”

“Expanded Medicaid funding for school health services is good for students. It’s good for school and it’s good for public health,” Davis added.

The guidance issued today also clarifies to states that they cannot impose restrictions on the mental health services offered to children. For example, states can no longer deny mental health services to children in Medicaid who don’t yet have an official mental health diagnosis. Currently, if a child didn’t have a specific diagnosis, the experts say it can be challenging for children to access mental health care like therapy or prescription drugs.

“If I’m working with a young child it may take awhile to decide what the diagnosis is. I want to be able to support that child and I don’t want to have to wait until something emerges, but there has been an administrative barrier there,” said Dr. Marian F. Earls, a pediatrician who serves as the chair of the American Association of Pediatrics council on Healthy Mental & Emotional Development. “This is a wonderful first step.”

Earls has seen what removing that administrative barriers can do in her own state of North Carolina. She worked closely with the state’s Medicaid director to eliminate the same administrative barrier and it improved kids’ access to care almost immediately.

“It was huge. It was huge,” Earls said. “And it really led to the ability of (pediatric) practices in my state to begin to integrate a mental health professional into their practice.” Having a mental health care professional on staff allowed the practice to care for a child’s physical and mental health.

“It really facilitates early identification and support,” Earls said. Proactively addressing mental health problems can keep kids out of the emergency room with a crisis.

Davis believes the Biden administration’s announcement today could make a huge difference to improve this generation of student’s physical and mental health.

“I think it will be transformative,” she added. “And bottom line this is good for students. It’s good for schools, and it’s good for the public because it is using federal resources very efficiently.”

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