Source: United States Senator for Colorado Michael Bennet
Washington, D.C. – Today, Colorado U.S. Senator Michael Bennet called on the Centers for Medicare & Medicaid Services (CMS) to swiftly update Medicaid guidance on providing health care, including mental and behavioral health services, in school-based settings. As school starts across Colorado and the nation, state Medicaid agencies, local educational agencies, and school-based entities need clear guidance to reduce red tape and increase access to services that address the youth mental and behavioral health crisis.
Schools are uniquely positioned to meet the mental and behavioral health needs of children. As of 2014, schools can use Medicaid funding to provide health services to students, but to date, less than half of states have expanded or started to expand Medicaid coverage in schools. This patchwork of policies has led to disparities in access to mental and behavioral health services at a time when students need them the most.
“Updating federal guidance regarding Medicaid funding for services in school-based settings is long overdue and urgently needed to help address the youth mental and behavioral health crisis,” wrote Bennet in the letter to CMS Administrator Chiquita Brooks-LaSure. “Prior to the Coronavirus Disease 2019 (COVID-19) pandemic, up to 1 in 5 children ages 3 to 7 in the U.S. reported a mental, emotional, developmental, or behavioral disorder. The pandemic has caused a surge in rates of depression, anxiety, trauma, loneliness, and suicidality among young people. In addition to these COVID-19 stressors, more than 140,000 children in the U.S. have lost a primary and/or secondary caregiver in the last two years.”
The recently-passed Bipartisan Safer Communities Act instructed CMS to issue updated guidance for state Medicaid programs, local educational agencies, and school-based settings to implement and expand school-based health programs. This guidance will include best practices for accessing Medicaid funding, identifying eligible providers, and utilizing telehealth to deliver mental and behavioral health services in schools, helping more kids receive the support they need.
“State Medicaid agencies, local educational agencies, and school-based entities need clear guidance and help reducing administrative burden to provide better support to kids during this crisis. To that end, I ask that CMS urgently work to issue the new guidance and provide my office with an expected timeline for release,” Bennet concluded.
In September 2021, Bennet and U.S. Senator John Cornyn (R-Texas) released “A Bold Vision for America’s Mental Well-being,” a white paper outlining a new framework for reimagining and redesigning how mental and behavioral health care is delivered in the United States. This framework included principles to better integrate mental health care and enhance delivery within local communities, including in school-based settings.
The full text of the letter is available HERE and below.
Dear Administrator Brooks-LaSure:
In June 2022, Congress passed and President Joe Biden signed the Bipartisan Safer Communities Act to address gun violence, improve school safety, and invest in mental and behavioral health. Under Section 11003 of the act, the Centers for Medicare & Medicaid Services (CMS) has been tasked with issuing “guidance to State Medicaid programs, local educational agencies, and school-based entities to support the delivery of medical assistance to Medicaid and CHIP beneficiaries in school-based settings.” Updating federal guidance regarding Medicaid funding for services in school-based settings is long overdue and urgently needed to help address the youth mental and behavioral health crisis.
Prior to the Coronavirus Disease 2019 (COVID-19) pandemic, up to 1 in 5 children ages 3 to 7 in the U.S. reported a mental, emotional, developmental, or behavioral disorder.[1] The pandemic has caused a surge in rates of depression, anxiety, trauma, loneliness, and suicidality among young people. In addition to these COVID-19 stressors, more than 140,000 children in the U.S. have lost a primary and/or secondary caregiver in the last two years.[2] In May 2021, Children’s Hospital Colorado underscored how suicide has become the leading cause of death for Colorado’s children and the increasing demand for health services by declaring a “State of Emergency” in youth mental health.[3] As CMS has previously found, schools can fill a critical role in identifying and connecting children with mental and behavioral health services.[4]
While Medicaid expenditures for school-based health services have increased since CMS changed its guidance on “free care” in 2014, less than half of States have expanded or started the process of expanding Medicaid coverage in schools.[5],[6] New flexibility to expand Medicaid reimbursement has led to a patchwork of policies that provide different degrees of support for school-based health services. Students of color, those from lower socio-economic backgrounds, and kids living in rural areas are most negatively affected by disparities in coverage and access to services.
I appreciate the recently released Center for Medicaid and CHIP Services Information Bulletin pointing to existing guidance and strategies,[7] however updated federal Medicaid guidance for school-based services is desperately needed. State Medicaid agencies, local educational agencies, and school-based entities need clear guidance and help reducing administrative burden to provide better support to kids during this crisis. To that end, I ask that CMS urgently work to issue the new guidance and provide my office with an expected timeline for release.
I appreciate your timely consideration of this matter.
Sincerely,
[1] U.S. Department of Health and Human Services. “Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory.” (2021). Accessed on September 7, 2022: https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
[2] American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association. “Declaration of a National Emergency in Child and Adolescent Mental Health.” (October 19, 2021). Accessed on September 7, 2022: https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/
[3] Children’s Hospital Colorado. “Children’s Hospital Colorado Declares a ‘State of Emergency for Youth Mental Health.’” (May 25, 2021). Accessed on September 7, 2022: https://www.childrenscolorado.org/about/news/2021/may-2021/youth-mental-health-state-of-emergency/
[4] CMS. “Guidance to States and School Systems on Addressing Mental Health and Substance Use Issues in Schools.” (July 1, 2019). Accessed on September 7, 2022: https://www.medicaid.gov/federal-policy-guidance/downloads/cib20190701.pdf
[5] Ibid.
[6] Healthy Students, Promising Futures. “School Medicaid Programs.” (June 2021). Accessed September 7, 2022: https://healthystudentspromisingfutures.org/map-school-medicaid-programs/#0
[7] CMS. “Information on School-Based Services in Medicaid: Funding, Documentation and Expanding Services.” (August 18, 2022). Accessed on September 7, 2022: https://www.medicaid.gov/federal-policy-guidance/downloads/sbscib081820222.pdf