Fact Sheets

Delivering Service in School-based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming

Overview: A Long-awaited Guide to Help Schools Give Care to Children in Medicaid and CHIP

The Centers for Medicare & Medicaid Services (CMS) is releasing Delivering Service in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming. Developed in consultation with the U.S. Department of Education, the new guide represents an important part of the Biden-Harris Administration’s work implementing the Bipartisan Safer Communities Act (BSCA). BSCA charged CMS with expanding access to Medicaid health care services in schools, including behavioral health services, and reducing administrative burden for states and schools.

The Guide’s Purpose: Increasing Access by Decreasing Administrative Burden

The guide offers new flexibilities and consolidates existing guidance, making it easier for all schools, no matter their size or the resources available to them, to receive payment for delivering Medicaid-covered services. Schools are a key but often overlooked setting for health access and equity. Together, Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage for over half of all children in the United States.

States can adopt flexibilities outlined in the guide to reduce the administrative burden for schools significantly, making it easier to get paid for covered health services delivered to children enrolled in Medicaid and CHIP. By making it easier for schools to bill Medicaid and CHIP, small, rural, and under-resourced schools can provide more services, thereby improving health care access for children with Medicaid and CHIP coverage.

Why the Guide Matters: Delivering Crucial Care to Students Where They Are

Medicaid and CHIP are already lifelines for more than 41 million children in the U.S. Delivering health care services in schools is an opportunity to provide crucial care to these children where they spend most of their time.

This comprehensive policy guide demonstrates the ways states can build a bridge between education and health care to support all eligible children receiving the health care services to which they are entitled.

Access to school-based health care services has been shown to improve health and academic outcomes. Examples of care that can be delivered at school include:

  • Preventive care
  • Behavioral health
  • Physical and occupational therapy
  • Disease management

What the Guide Provides: The Guidance and Flexibilities Schools Need

The guide clarifies, consolidates, and expands on a wealth of CMS guidance on both how schools can receive payment for providing direct medical care and how states can ease the administrative burden on school-based providers to promote their participation in Medicaid and CHIP while meeting federal statutory and regulatory requirements. This guidance includes helping states and schools operationalize:

  • How payments can be made to schools for Medicaid and CHIP school-based services;
  • How states can simplify the interim billing process, when used, including in rural, small, or under-resourced communities, where access to care may be particularly problematic;
  • Examples of approved methods that state agencies have used to pay for covered services; and
  • Enrolling qualified health care providers to participate in Medicaid within school settings

View the full guide or the informational bulletin for more information.