Medicaid and School Based Services

Published by

TracyC

on

June 3, 2025

By Tracy Christenson and Holly Christopher

Physical and mental health services support are essential for schools in the 21^st century, and federal school-based services provide important resources. In spite of increasing mental health concerns among students, the Centers for Medicare & Medicaid Services (CMS) have noted signs that use of primary, preventative, and mental health services, particularly has declined. In response, the CMS and U.S. Department of Education (ED) have teamed up to expand school-based health services to try to meet the increasing demands.

Medicaid School-Based Services (SBS) include mental and behavior health services as well as other health services that are provided for children covered by Medicaid in a school setting. The costs for these services are reimbursed to the schools by using both state and federal Medicaid funding. SBS includes:

School nursing
School counseling
Occupational & physical therapy
Speech language pathology
School-based health centers
Dental services
Vision and hearing screenings
Audiological services
Substance use services
Vaccination clinics

SBS may partner with community health providers or can hire permanent staff to provide these services. These services particularly benefit students with disabilities by improving their school attendance, reducing the stigma they may suffer from their disability and the support they require, reducing future health issues through preventative care, and reducing time and cost in dealing with health issues.

The Medicaid School-Based Services (SBS) Technical Assistance Center (TAC) is dedicated to ensuring that students have access to the health services and support they need. The TAC is helping state Medicaid agencies (SMAs), state educational agencies (SEAs), local educational agencies (LEAs), and school-based entities to expand health care services in schools and SBS programs. The goals include improving health care access for students using Medicaid and the Children’s Health Insurance Program (CHIP) and meeting Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements. Medicaid and the Children’s Health Insurance Program (CHIP) combined provide health coverage for about 50% of American children.

The CMS offers a detailed guide for schools, Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming. This guide was developed as part of the Bipartisan Safer Communities Act (BSCA), which gave CMS the task of expanding access to Medicaid health care services in schools. This expanded access includes behavioral health services. The guide explains how schools can more easily receive payment when they offer services that are covered by Medicaid, reducing their administrative burden.

IDEA Services and Medicaid

The collaboration between ED and CMS has been critical to developing Medicaid guidance and resources for schools. It has allowed local education agencies (LEAs) to make better use of the Individuals with Disabilities Education Act (IDEA) and increase use of other Medicaid-eligible services.

IDEA is a law that enables children with disabilities to have access to Free and Appropriate Public Education (FAPE) as outlined in the student’s Individualized Education Program (IEP) at no cost to their families. It includes access to special education and, when necessary, early intervention services for infants and toddlers with disabilities. The services offered under IDEA must be free to the recipients and their families, and Medicaid can be the payer of first resort. Also, even when someone has received IDEA services in a school setting, it doesn’t limit their access to other Medicaid services provided outside of the school.

Federal IDEA funding only covers about 16% of the educational costs for children with disabilities. States and local governments typically carry the burden for the remaining costs, which is why Medicaid reimbursements for SBS are so important.

Federal Mental Health Resources

Because mental health is a critical issue for today’s students, it’s important to note that there are many federal agencies that offer support and resources for schools. Federal organizations that offer mental health resources include the CMS and ED, but also the CDC, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Health Resources and Services Administration (HRSA). In fact, SAMHSA partners with schools to expand the use of the 988 Suicide and Crisis Lifeline, which is available to anyone who is experiencing a mental health crisis, who needs help with substance abuse issues, or who is suicidal.

For more information, there is a list of resources:

SAMHSA Resources

HRSA & SAMHSA Resources

Advancing Comprehensive School Mental Health Systems

CDC Resources

Other Resources

More Information

For more information about Medicaid School-Based Services (SBS), please visit the Medicaid School-Based Services Frequently Asked Questions (FAQs) or contact the TAC at SchoolBasedServices@cms.hhs.gov with questions, feedback, or requests for technical assistance.

Sources

Delivering Service in School-based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming – Fact Sheet. May 18, 2025. Accessed May 29, 2025. https://www.cms.gov/newsroom/fact-sheets/delivering-service-school-based-settings-comprehensive-guide-medicaid-services-and-administrative

Individuals with Disabilities Education Act (IDEA). US Department of Education. Accessed May 29, 2025. https://www.ed.gov/laws-and-policy/individuals-disabilities/idea

Medicaid & School Based Services. Accessed May 24, 2025. https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-and-school-based-services

U.S. Department of Education School-Based Services Resources. Accessed May 29, 2025. https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-school-based-services/us-department-of-education-school-based-services-resources