Currently, many young people are experiencing considerable mental health challenges; Medicaid school-based behavioral health services can play a crucial role in their health and wellness. Federal policymakers have an opportunity to optimize federal resources and new Medicaid flexibilities for states to increase access to mental health services in schools. Collaborative models, such as the Centers for Disease Control and Prevention’s Whole School, Whole Community, Whole Child (WSCC) model, demonstrate how the education, school health, and public health sectors can work together to improve children’s health and well-being.
School-based health services (SBHS) have been associated with positive outcomes, especially for children at increased risk for poor mental health, and have garnered interest from policymakers and advocates. Making services available in school-based settings increases access by reducing transportation and geographic barriers, as well as easing caregiver burden by eliminating the need for parents or guardians to take time off from work. However, schools expanding SBHS face significant challenges securing adequate funding, as well as in recruiting and retaining behavioral health providers. A 2022 study found that only 12 percent of public schools “strongly agreed” they could successfully deliver mental health services to all students in need. Provider shortages were the most reported limitation.
Last year, Congress increased funding to improve the availability of mental health services, including SBHS. Through the Bipartisan Safer Communities Act (BSCA), Congress provided additional funding to strengthen the capacity of schools to meet children’s behavioral health needs. The Consolidated Appropriations Act of 2023 also provided much needed funding infusions to address the nation’s behavioral health challenges, including $111 million to grow Department of Education programs designed to increase the availability of mental health services in schools, including by expanding training programs to prepare new school counselors, social workers, and psychologists.
As required by BSCA, the U.S. Department of Health and Human Services Secretary, along with the Education Secretary, issued a comprehensive guide to support the delivery of SBHS to Medicaid and Children’s Health Insurance Program beneficiaries in school-based settings and established a Technical Assistance Center (TAC) to help schools and school districts leverage federal funding for Medicaid-covered behavioral health services. The guide offers new flexibilities state Medicaid agencies may adopt to ease administrative burdens on schools, school districts, and school-based providers, especially in low-income and rural communities. For example, new flexibilities to simplify billing and documentation requirements can help providers spend more time delivering services and less time on paperwork. Granting states greater latitude to establish qualifications for school-based providers and to pay higher rates for their services can alleviate the short supply of behavioral health professionals. States can immediately take advantage of these flexibilities by submitting applicable amendments to their Medicaid plans.
The TAC will help state Medicaid agencies and schools navigate the complexities of financing school-based Medicaid services and improve coordination at the federal level for Medicaid-covered mental health services. Over the coming months, the TAC will develop additional resources, including more detailed guidance on billing. Stakeholders are welcome to suggest topics for other guidance at [email protected].
Despite the recent funding infusion, additional federal investments are needed to address chronic underfunding of the behavioral health system, especially the workforce that delivers behavioral health services in school-based settings. The expiration of the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act on September 30 provides the next opportunity for Congress to strengthen the pipeline of behavioral health professionals. The House Energy and Commerce Committee unanimously advanced bipartisan legislation to reauthorize the SUPPORT Act. The Senate Health, Education, Labor, and Pensions (HELP) Committee has not yet reached a deal on SUPPORT Act reauthorization and is instead prioritizing bipartisan talks on primary care and health workforce legislation. The recently released Bipartisan Primary Care and Health Workforce Act by Chairman Bernie Sanders (I–Vt.) and Sen. Roger Marshall (R–Kan.) provides $55 million to establish new school-based health services and $3 billion in capital funding intended to help community health centers increase dental and mental health services. This proposal was advanced favorably by the HELP committee on September 21.
As lawmakers put together a fall health care package, they can help ensure there are adequate professionals for states to take advantage of new Medicaid flexibilities. Any congressional action to combat the worsening youth mental health crisis must address provider shortages, especially in schools, if we are to meet the demand of the next five years and beyond. Ensuring there are enough providers to support youth mental health is an important part of a coordinated approach to delivering comprehensive student wellness.