The Illinois School-Based Health Services program received CMS approval on April 18th, which allows the state to expand access to school-based healthcare services (SBHS) for Medicaid-enrolled children.
Currently, local education agencies can only receive federal reimbursement for services to a limited group of students who meet the state’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) eligibility—programs tailored to children with disabilities.
The approved state plan amendment allows schools to receive more federal Medicaid funding to provide covered services to all children with Medicaid.
These services include preventive care, physical and occupational therapy, and behavioral health services. State leaders praised the decision on Thursday, committing to support the healthcare needs of children.
“For many Illinois children, school isn’t just a place to learn and build skills—it’s also a place where many families can access services that are otherwise unobtainable to them, like behavioral healthcare or occupational therapy,” Gov. JB Pritzker said following the approval.
“Thanks to the Biden administration and my Department of Healthcare and Family Services (HFS), more families will be able to access necessary healthcare and schools won’t be burdened with additional costs, making children healthier and our state stronger.”
As part of its implementation of the Bipartisan Safer Communities Act, CMS said it planned to launch a new school-based services Technical Assistance Center in partnership with the US Department of Education and release a notice of funding opportunity for $50 million in grants to states to strengthen school-based health services.
“We’re thrilled to partner with states like Illinois to seize opportunities in Medicaid to expand access to healthcare in schools,” CMS Administrator Chiquita Brooks-LaSure said. “CMS encourages all states to consider adopting this flexibility. It just makes sense to deliver healthcare services and supports to children where they spend the majority of their time: in school.”
HFS anticipates the expansion and update to the program will bring tens of millions of additional federal Medicaid dollars annually to Illinois schools.
“Schools are a critically important setting for offering health screenings and services, and especially behavioral health, to our youth in Illinois,” HFS Director Theresa Eagleson said in a statement. “This approval means that the services offered in school will be available to more Medicaid-enrolled children, which we believe will go a long way toward improving health outcomes for youth across the state.”
Currently, 850 school districts take part in the SBHS program. HFS told State of Reform with the eligible population increase within each district, the number of Medicaid billable services is expected to rise.
HFS conducts training, reporting, and extensive claiming of federal funds on behalf of Illinois schools. SBHS administrators initiated training last week to prepare school districts for any changes in reporting that result from the state plan amendment.
The funding will cover reimbursement to social workers, school health aides, and nurses working with students in the school setting.
“We are thrilled that this legislation has gained approval,” Illinois Association of School Nurses President Bridget Heroff told State of Reform. “By expanding the Medicaid reimbursement for school-based health services, we are hoping to see more school nurses throughout the state.
These services are vital to the health and safety of our students, and there is no one more qualified to provide medication administration and health assessments than a school nurse. We look forward to continuing our partnership with other school-based support personnel groups and will continue to advocate for a school nurse in every building across the state. All students in Illinois deserve access to a school nurse, regardless of their zip code.”
Speaking to State of Reform, John Walkup, MD, chair of the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children’s Hospital in Chicago, noted that while training professionals with mental health experience to work in schools will be essential, equally important will be to build the capacity of the health system to serve those students, which will take time.
“Then from a systems change point of view, just understanding that those people—once they go to work, if they’re really doing a good job—they’re going to identify a lot of kids,” Walkup said. “And those kids are going to need to be either evaluated within the school environment—so resources have to be there—or the referral will go out into the community and some will have to do the work out there.
So it really takes a variety of child-facing systems to get the whole job done for all kids, but the critical component that we have currently is a real shortage of providers who can do the really good diagnostic workups and treat on the spot.”
Walkup will be speaking on the “Interventions to Improve Children’s Behavioral Health” panel at the inaugural 2023 Illinois State of Reform Health Policy Conference on June 8th at the Sheraton Grand Chicago Riverwalk. You can register here if you haven’t already!