Federal policy change provides new opportunities for school health services
In 2014, the federal government reversed a long standing policy that impeded the ability of school districts to get reimbursed for the school health services they provide to students (called the “Free Care Rule”). This reversal removes a major barrier for schools to obtain federal Medicaid funding for student health services and creates an opportunity for schools to expand the role they play in improving the health of low-income students. The change in federal policy could open the door for schools to reimagine their role in the health care delivery system and augment their efforts on behalf of children.
UPDATE: CMS approves California SPA 15-021
In April 2020, the Centers for Medicare and Medicaid Services (CMS) approved California’s State Plan Amendment (SPA) 15-021. This brings to a close the state’s five-year process to expand coverage of health services to all Medicaid enrolled students, per the change to the “free care rule.” SPA 15-021 expands access to Federal Medicaid funds for LEAs, through the following three primary changes: (1) incorporating Random Moment Time Survey (RMTS) into the cost settlement process, (2) adding new service practitioners and new services covered under the LEA BOP, and (3) expanding the population covered under the LEA BOP to include Medicaid beneficiaries outside of special education to those covered by an Individualized Health and Support Plan (IHSP) also known as a “Care Plan”.
Resources for Schools
- CDE and DHCS Collaboration Letter: State Plan Amendment 15-021 (June 2020)
- DHCS factsheets
- Brief: Enhancing Services for Students: California Local Education Agency Medi-Cal Reinvestments
To participate in the Medi-Cal Billing Option Program, Local Education Agencies (LEAs) are required to reinvest the federal reimbursement received into services that support students and their families. This brief describes requirements for reinvestments and reviews themes and best practices from LEAs that use this revenue to support special education and overall student health services.
- REPORT: Policy Considerations for California Following the 2014 Reversal of the Medicaid “Free Care Rule”
With our partners, The California Endowment and Harbage Consulting, we are excited to release a report that offers insight into California’s implementation of this change and highlights new possibilities to expand the role of schools in contributing to broad health system transformation. Schools have regular access to children, provide education and preventive, ongoing, and follow-up services, and are trusted by children and parents.
- WEBINAR: Free Care Reversal and Recommendations for CA
This webinar provides an overview of the findings in our report and addresses many questions from the audience.