2019 WVAHC Medicaid Summit
The National View: Medicaid in Schools Kyle Marie Stock, J.D. Senior Policy Analyst
Community Catalyst’s System of Advocacy
Thank You
Connecting Health & Education
Medicaid Billing in Schools: What Tools Do We Have? • IDEA related services for students • Other health services for Medicaid-eligible students • School-based health centers • Outreach & enrollment
What is the “Free Care” Policy Reversal? • CMS reversed the “free care” policy in 2014 • Allows schools to bill for services provided to any Medicaid enrolled student • Some states are moving forward with implementation
Case Study: South Carolina • Did not need State Plan Amendment • Now permits billing for all Medicaid enrolled students
Case Study: Louisiana • 2015 State Plan Amendment • Limited to school-based nursing services • Unofficial estimates show: • Increased Medicaid revenue • More nurses in schools
Case Study: Massachusetts • 2016 State Plan Amendment • Effective for school year 2019-2020 • What changed? • Permits billing for all Medicaid enrolled students • Adds services & provider types • New methodology
Case Study: North Carolina • 2019 State Plan Amendment • What changed? • Permits billing for all Medicaid enrolled students • Adds services & provider types
Other States in Process • Approved SPA • FL • SPA Submitted • CA, GA, KY • Moving Toward Policy Change • CO, MO, NV, NH, UT
Thank you.
The WVAHC Perspective
Kelli Caseman Kelli is the Director of Child Health for West Virginians For Affordable Health Care and the West Virginia Kids’ Health Partnership. She has over 15 years of experience working in the fields of children’s health and education. She is a member of the Robert Wood Johnson Foundation’s Interdisciplinary Research Leaders program, studying the linkages between health care and public education in rural West Virginia with researchers at Child Trends and Penn State University.
Agenda • Medicaid and School Health from the West Virginia Perspective - Highlights from the Brief Federal rules vs. state flexibility State Medicaid plan When can schools bill? IDEA, IEP and 13 categories of special education State Stats: How much is WV billing? • Putting It into Perspective: The Need for More Health Services in Schools • The Children’s Health Collaborative Project
A Snapshot of Our Kids’ Health 43 rd in the well-being of children in the state. • The 2019 Kids Count Data Book ranks West Virginia 43 • Rural West Virginians struggle with accessibility to health care, with 52 52 of 55 55 counties designated as Medically Underserved Areas/Populations by the Health Resources and Services Administration (HRSA). • According to the WV Department of Health and Human Resources, between 2014 and 2017, our state saw a 46% 46% increase of children in state custody, a 22% 22% increase in abuse/neglect referrals and a 34% 34% increase in open CPS cases over 3 years. We remain number one in the country for child removals. Around 85% 85% of these cases involve drug use.
A Snapshot of Our Kids’ Health
Copies are in Summit attendee packets. Also available for download at our website, www.wvahc.org, or via USPS by emailing info@wvahc.org.
The Federal Rules for Medicaid Funding for Student Health Services Three Ways Medicaid Can Pay: 1. IDEA related services for students with Individualized Education Program (IEP) 2. School-based health centers 3. Other health services for Medicaid-eligible students
Medicaid Matters to WV Schools : In a Nutshell Public schools bill Medicaid for services to students with an IEP & parental consent. School-Based Health Clinics can bill for any Medicaid services that are covered under the Medicaid State Plan & under authority of EPSDT (but not for IEP-related services). o WV public schools (school nurses & other school-employed Medicaid qualified providers) do NOT bill Medicaid for services provided to Medicaid enrolled students that are provided free to other students, such health exams or chronic disease management - even though federal “free care rule” that prohibited this billing is no longer in place.
WV Medicaid : Fills in IDEA Funding Shortfalls To qualify for IDEA Medicaid funding, State Plan Amendment 12-006 1. Fit under one of 13 categories of disabilities 2. Individualized Education Plan (IEP) • Team with required members • Written document • Reviewed annually – re-evaluated every 3 years • Broad range of services – but does not cover: • IEP plan development • Other changes to how certain ancillary services billed • SFY 2017 $23.4 million
West Virginia : Medicaid and Schools • IDEA services pursuant to an IEP plan- There were 47,183 students ages 3 through 21 with an IEP as of 12/18– about 17.8% of all West Virginia public school students . • School-based health centers (SBHCs)- Nearly 170 SBHCs (For context, there are 690 public schools in WV)
Putting It Into Perspective: The Need for More Health Services in Schools
Putting It Into Perspective • As part of the Children’s Health Collaborative Project, WVAHC surveyed over 4000 school personnel, health care providers and community stakeholders around the state. We received 789 auditable responses. • Key findings: 88% believed there were children in their communities in need of health care but not receiving it; 87% of respondents believed that schools are appropriate place to receive health care. Mental health care was identified as the #1 needed service students weren’t receiving.
The Political Landscape • WV Governor Jim Justice signed HB 206– “The Education Bill”—on June 28. One of the few areas of agreement between legislative Republicans and Democrats on education reform included wraparound services for students with emotional or developmental needs . HB 206 includes more than $30 million for putting more mental health professionals — counselors, psychologists, and nurses — in schools. The funding will allow for five mental health professionals per every 1,000 students. The bill also requires counselors to spend 80 percent of their time on direct counseling — up from 75 percent previously.
WVAHC’s Work to Expand School Health Services In 2017, WVAHC received a Community Transformation Grant to create the Children’s Health Collaborative Project. Our work entailed bridging health care and schools at the community level, with the end goal of creating policy reform and cultivating grassroots support. • Conducted a statewide surveying project • Wrote a survey project report and “launched” the CHC project via press conference • Held a meeting/webinar highlighting WVDE/WVDHHR efforts to address mental health services in schools • Wrote a second brief, detailing Medicaid services in WV schools • Held a joint webinar with Community Catalyst to report our brief findings • Held four community dinner/discussion meetings around community-level policies connecting health care and schools What have we learned (so far)? • Few county school systems/schools have health care policies in place, such as procedures for collecting health insurance or referring kids to care. • Few policymakers/legislators understand the complexities of Medicaid billing. • Few school health staff “like” billing Medicaid-- it takes time, is complex, and reimbursement is low. Sometimes, they don’t do it. • No one disagrees that our kids are in crisis.
Next Steps • Hold at least three more community meetings (and maybe more) • Disseminate Medicaid Matters to West Virginia Schools, Part II – which will focus on opportunities for expanding Medicaid services • Hold a webinar exclusively for parents- a pseudo-focus group/listening session to hear their thoughts on expanding health services in schools. • Conduct a two-hour session on school health services at WVAHC’s upcoming annual Medicaid Summit. • Draft a three-year strategic plan to carry on this work after the RWJF grant ends in September.
A State Director’s Perspective Cynthia A.Parsons Program Director Behavioral Health & Long Term Care Services West Virginia Bureau for Medical Services
A School Nurse’s Perspective Brenda C. Isaac BSN, RN, MA, NCSN Lead School Nurse Kanawha County Schools
Discussion
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