Pennsylvania Receives Federal Grant to Enhance School-Based Health Services
In June, on the two-year anniversary of the Bipartisan Safer Communities Act, the Centers for Medicare & Medicaid Services (CMS) awarded grants to 18 states, including Pennsylvania, to fund the implementation, enhancement, and expansion of Medicaid and the Children’s Health Insurance Program (CHIP) school-based health services. Pennsylvania will receive $2.5 million over the next two years to expand the existing Medicaid School-Based ACCESS Program (SBAP).
Pennsylvania schools are mandated by federal law, specifically the Individuals with Disabilities Education Act (IDEA), to provide all necessary health-related services outlined in a child’s Individualized Education Program (IEP) starting at age 3. The additional funding available to Pennsylvania allows school districts and intermediate units to offer school-based health care services to students enrolled in Medicaid. Children and youth across Pennsylvania regularly receive medical services in schools, including physical therapy, speech therapy, occupational therapy, and mental and behavioral health services. The School-Based Access Program (SBAP) allows participating schools to bill Medicaid for these various services.
It is common for teachers and other school professionals to be the first to identify health-related issues that affect students' academic progress and overall development. Schools serve as a venue for the early identification of health needs and for connecting students to a wide range of physical and behavioral health services.
The Medicaid School Based Access Program supports schools by:
- Helping eligible students enroll in the Medicaid program.
- Connecting students’ Medicaid-eligible family members with Medicaid health coverage.
- Providing Medicaid-covered health services in schools and seeking payment for services furnished. Health services can include any covered service, including EPSDT services, at the State Medicaid agency’s discretion.
- Offering Medicaid-covered services that support at-risk Medicaid eligible students.
- Providing Medicaid-covered services and performing Medicaid administrative activities to improve student wellness.
- Providing Medicaid-covered services that reduce emergency room visits.
- Providing Medicaid-covered services and performing Medicaid administrative activities that promotes a healthy environment and promotes learning.
Even if a school does not directly provide medical services, it can conduct outreach and enrollment activities for Medicaid and the Children's Health Insurance Program (CHIP) and receive reimbursement for these efforts.
For state Medicaid programs to reimburse schools for providing health services, these services must be included in the Medicaid statute and covered within the state’s Medicaid plan, or they must be available under the mandatory Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirement of the Medicaid program.
Sally Kozak, Deputy Secretary for the Department of Human Services' Office of Medical Assistance Programs (DHS-OMAP) announced Pennsylvania's receipt of this grant during the June Consumer Subcommittee meeting of the Medical Assistance Advisory Committee (MAAC). Ms. Kozak stated that the purpose of the grant is to enhance Pennsylvania's efforts to connect more children to essential healthcare services, particularly mental health services, through schools. She reported that DHS will collaborate with the Department of Education to improve and expand the services offered to Medicaid-eligible students through the School-Based Access Program (SBAP). Ms. Kozak indicated that the state will initiate the grant activities by gathering feedback from stakeholders such as local education agencies to identify needs and potential pathways to support these agencies with the costs associated with providing health-related in-school services.
For general questions or comments regarding school-based services, please contact SchoolBasedServices@cms.hhs.gov. Pennsylvania school districts or local education agencies interested in enrolling in the Medicaid School Based ACCESS Program can learn more here. We will provide more information on the state's implementation of this grant as it becomes available.
