Opportunities to Expand and Optimize Medicaid Managed Care in Schools

Nationwide, schools play a critical role in helping children and youth access important health care services; this role is especially important for children and youth who face barriers to care in their communities. A key focus of the Healthy Schools Campaign is expanding Medicaid-funded school health services to maximize reimbursement to school districts and promote reinvestment that helps assure their financial sustainability. In many states, school districts can bill for certain Medicaid services directly through the state; however, some states include school services within their Medicaid managed care delivery system. On behalf of Healthy Students, Promising Futures (an initiative of the Healthy Schools Campaign), Aurrera Health Senior Policy Consultant Liz Stein and former Aurrera Health team member Tanya Schwartz wrote Medicaid Managed Care and School Health Services: Early Lessons & Opportunities, an issue brief that details how state officials, school health officials, and managed care organizations (MCOs) in California, South Carolina, Tennessee, and Washington have worked to integrate school health services into their Medicaid managed care delivery. Learning from the experience and promising practices of school districts and MCOs can help maximize and improve partnerships for others who seek to improve their delivery model or are considering a new path. The report findings are organized around three topics:

• Relationship-building between state agencies, managed care organizations, and school districts 

• Understanding how Medicaid MCO requirements (e.g., billing and contracting) impact school districts 

• Evaluating data and care coordination 

Each topic area includes specific actions that Medicaid state agencies and MCOs can adopt to support school districts. 

Key Takeaways 

• State Medicaid agencies should play a strong role in bringing together partners in the health care and education sectors.

• To reduce the administrative burden on school districts, state Medicaid agencies should consider options to standardize processes across MCOs so school districts can easily engage with managed care and ensure that they are properly reimbursed for services.

• State Medicaid agencies, MCOs, and school districts should adequately facilitate and prioritize data-sharing and care coordination to ensure that both MCOs and school districts have the requisite information needed to deliver quality care.

Aurrera Health Group Can Help You

If you are interested in learning about how Aurrera Health can help advance school-based health policies in your state, please reach out to Liz Stein. To learn more about our work, read our blog, follow us on LinkedIn, and subscribe to our monthly newsletter. 

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Author

Liz Stein [Senior Policy Consultant]