Medicaid, Children’s Health Insurance Program (CHIP) make it possible for low-income Americans, specifically children and families, to access free or low-cost health care. While some may not be familiar with the role of school-based Medicaid, others may be familiar with its primary role funding special education services to millions of students in need of individualized education plans (IEPs). A well-developed Medicaid in Public Schools (MIPS) program can bolster one of states’ largest expenditures, public education. Public schools are “among the most efficient systems to reach children and families” in terms of determining and enrolling Medicaid-eligible children and/or families.
While use of Medicaid funds varies, a 2017 School Superintendents Association study found nearly 70 percent of schools use Medicaid reimbursement dollars for salaries of health care professionals; 45 percent to expand health services; and 39 percent to facilitate outreach and coordinate services for students.
To qualify, an individual must meet both 1) categorical eligibility and 2) financial eligibility. Many children are first identified, enrolled through public schools. To qualify for MIPS in Nebraska:
- Services must be medically necessary
- Student recipients must be eligible for Medicaid
- Associated special education or family support services MUST be included in their Individual Education Plan (IEP) and/or Individualized Family Service Plan (IFSP).
Nebraska Department of Health and Human Services defines medical necessity as:
- Necessary to meet the basic health needs of the client
- Rendered in the most cost-efficient manner
- Rendered in a type of setting appropriate for the delivery of the covered service
- Consistent in type, frequency, and duration of treatment with scientifically based guidelines of national medical, research, or health care coverage organizations or government agencies
- Consistent with the diagnosis of the condition
- Required for means other than convenience of the client or the physician
- No more intrusive or restrictive than necessary to provide a proper balance of safety effectiveness, and efficiency
- Relative to the goal of improved patient health outcomes
*Services and supplies which do not meet the definition of medical necessity are not covered. This definition is provided for purposes of Medicaid fee-for-service and Managed care.
A Medicaid-eligible child may receive some, or all, of the following health care services via Nebraska’s Medicaid school-based health services, MIPS program:
All Nebraska Medicaid Covered Services
- Ambulance services
- Chiropractic services
- Dental services
- Durable medical equipment, orthodontics, prosthetics, and medical supplies
- Family planning services
- Early and Periodic Screening, Diagnostics, and Treatment (EPSDT), Health Check
- Hearing aid services
- Home health agency services
- Hospice services
- Hospital services
- Intermediate care facilities (ICF) for persons with developmental disabilities (ICF/DD)
- Laboratory and radiology (X0ray) services
- Medical transportation services
- Mental health and substance abuse services for children and adolescents
- Nursing facility services
- Nurse Midwife services
- Nurse Practitioner services
- Nursing services
- Physician services
- Podiatry services
- Prescribed drugs
- Private-duty nursing services
- Adult psychiatric, Substance
- Use Disorder, and Medicaid rehabilitation option
- Screening services (mammograms)
- Services provided by clinics
- Therapies: physical, occupational, speech pathology & audiology
- Visual care services
All Nebraska Medicaid in Public Schools Covered Services
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Health Check
- Medical Transportation Services
- Mental Health and Substance Use
- Disorder Services
- Nursing Services
- Occupational Therapy Services
- Personal Assistance Services
- Physical Therapy Services
- Services for individuals with Speech,
- Hearing, and Language Disorders
- Visual Care Services
*Provider personnel must be employed by or under contract with the school district, ESU, or approved cooperatives providing special education and related services.
**Eligible Nebraska Medicaid-eligible services overlapping with Nebraska MIPS-eligible services are bolded for emphasis.
In Nebraska, 88.6 percent of children eligible for Medicaid, CHIP are receiving coverage.29 As a result, approximately 11.4 percent of eligible children remain uninsured statewide, though they are both categorically and financially eligible.
As schools are one of the most effective partners in identifying, enrolling, and serving Medicaid-eligible children, changes to Nebraska’s state Medicaid program and its administration 1) reduce the state’s percentage of uninsured children, 2) increase service to Medicaid-eligible children, and 3) preserve continuity of service, ensuring brief, inconsistent lapses in eligibility don’t adversely affect enrolled the health and safety of enrolled children nor produce a cliff effect for a child’s household.
Respectfully, Holland Children’s Institute proposes revisiting Nebraska’s Medicaid-eligible children’s coverage, to produce better health outcomes with three technical changes:
1) Address Nebraska’s ‘free care policy’ language
- Consider amending current statutory language (Neb. Rev. Stat. § 68-911(4)) to omit the requirement that school-based reimbursable services when provided as part of an individualized education program (IEP) or individualized family service plan (IFSP)
2) Provide ‘continuous eligibility’ for Medicaid, CHIP
- Consider amending Nebraska’s six-month continuous eligibility standard to meet the federally recommended standard of 12-month continuous eligibility. Nebraska is one 16 states not currently offering 12-month continuous Medicaid and/or CHIP eligibility, while 34 states offer continuous eligibility for Medicaid or CHIP, and 19 offering it for both programs.
3) Provide Express Lane Eligibility for Medicaid, CHIP
- Consider utilizing express lane eligibility (ELE) to simplify the Medicaid/CHIP administrative process and name an express lane agency (ELA) to aggregate and provide all information required for state program eligibility determination and enrollment.
Proposed changes may increase Nebraska’s state Medicaid expenditures in the short term but provide return on investment through enrolled children’s 1) long-term academic achievement, 2) workforce participation rates, and 3) increased lifetime earnings. Additional savings may result from 1) decreased frequency of complex, cumbersome applications, 2) streamlining and harmonizing application/enrollee data collection, and 3) reduced administrative staffing costs to manage applications and data.
School-based health services are an essential component of providing Medicaid, CHIP Early and
Periodic Screening, Diagnostic, and Treatment (EPSDT) screenings as well as ensuring reliable,
quality services to participating children.
Expanding Medicaid in Public Schools is a path forward to increasing the health coverage of
Nebraska’s children through school-based health services. A school-based program focused
on EPSDT interventions is essential to building a healthy foundation for immediate and future
positive outcomes for children’s health.